European Child & Adolescent Psychiatry

, Volume 28, Issue 8, pp 1117–1127 | Cite as

Sleep problems and anxiety from 2 to 8 years and the influence of autistic traits: a longitudinal study

  • Jacqueline Uren
  • Amanda L. RichdaleEmail author
  • Sue M. Cotton
  • Andrew J. O. Whitehouse
Original Contribution


Whether or not childhood sleep problems and anxiety occur simultaneously, or one precedes the other, and any effect of autistic traits on this relationship remains unclear. We investigated longitudinal associations between sleep and anxiety at 2 years and sleep and anxiety at 8 years controlling for demographic variables. We also examined the additional influence of autistic traits at 2 years on sleep problems and anxiety at 8 years. Participants were from the Western Australian Pregnancy Cohort (Raine) Study, where 2900 pregnant women were recruited between 1989 and 1991 and their children assessed every 2–3 years thereafter. Demographic information was provided at 16–18 weeks gestation. Children’s sleep and anxiety at 2 and 8 years and autistic traits at 2 years were measured using the Child Behavior Checklist. Hierarchical multiple regression models tested the prediction of both anxiety and sleep problems at 8 years. Sleep problems at 2 years and 8 years, anxiety at 2 years, and autistic traits at 2 years were significantly associated with anxiety at 8 years. Sleep problems at 2 years and anxiety at 8 years were significantly related to sleep problems at 8 years. Each of these models explained about 20% of variance. Childhood sleep problems, anxiety and autistic traits are interrelated and can occur concurrently in young children, but the best predictor of poor sleep in middle childhood is concurrent anxiety and vice versa. Anxiety and sleep problems may be an early indicator of autism in young children and early autistic traits may also contribute to anxiety problems later in childhood.


Sleep Anxiety Autistic traits Childhood 



We would like to acknowledge the Raine Study participants and their families, the Raine Study team for cohort co-ordination and data collection, the NHMRC for their long-term contribution to funding the study over the last 25 years and the Raine Medical Research Foundation. Also the University of Western Australia, Curtin University, The Telethon Kids Institute, the UWA Faculty of Medicine, Dentistry and Health Sciences, the Women and Infants Research foundation, and Edith Cowen University for providing funding for core management of the Raine Study. AJOW is supported by a Senior Research Fellowship from the National Health and Medical Research Council (APP1077966). SMC is also supported by a Senior Research Fellowship (APP1136344).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Lehmkuhl G, Waiter A, Mitschke A, Fricke-Oerkermann L (2008) Sleep disorders in children beginning school: their causes and effects. Dtsch Arztebl Int 105:809–814. Google Scholar
  2. 2.
    Byers KC, Yolton K, Rausch J, Lanphear B, Beebe DW (2012) Prevalence, patterns, and persistence of sleep problems in the first 3 years of life. Pediatrics 129:276–284. CrossRefGoogle Scholar
  3. 3.
    Stewart ME, Barnard L, Pearson J, Hasan R, O’Brien G (2006) Presentation of depression in autism and Asperger syndrome: a review. Autism 10:103–116. CrossRefGoogle Scholar
  4. 4.
    Tikotzsky L, Sadeh A (2001) Sleep patterns and sleep disturbances in kindergarten children. J Clin Child Psychol 30:581–591. CrossRefGoogle Scholar
  5. 5.
    Price A, Wake M, Ukoumunne OC, Hiscock H (2012) Outcomes at six years of age for children with infant sleep problems: longitudinal community-based study. Sleep Med 13:991–998. CrossRefGoogle Scholar
  6. 6.
    Wake M, Morton-Allen E, Poulakis Z, Hiscock H, Gallagher S, Oberklaid F (2006) Prevalence, stability, and outcomes of cry-fuss and sleep problems in the first 2 years of life: prospective community-based study. Pediatrics 117:836–842. CrossRefGoogle Scholar
  7. 7.
    Hoedlmoser K, Kloesch G, Wiater A, Schabus M (2010) Self-reported sleep patterns, sleep problems, and behavioral problems among school children aged 8–11 years. Somnologie 14:23–31CrossRefGoogle Scholar
  8. 8.
    Sadeh A, Gruber R, Raviv A (2002) Sleep, neurobehavioral functioning, and behavior problems in school-age children. Child Dev 73:405–417CrossRefGoogle Scholar
  9. 9.
    Quach J, Hiscock H, Canterford L, Wake M (2009) Outcomes of child sleep problems over the school-transition period: Australian population longitudinal study. Pediatrics 123:1287–1292. CrossRefGoogle Scholar
  10. 10.
    Goodlin-Jones BL, Tang K, Liu J, Anders TF (2008) Sleep patterns in preschool-age children with autism, developmental delay, and typical development. J Am Acad Child Adolesc Psychiatry 47:930–938. CrossRefGoogle Scholar
  11. 11.
    Quine L (1991) Sleep problems in children with mental handicap. J Mental Defic Res 35:269–290Google Scholar
  12. 12.
    Thome M, Skuladottir A (2005) Changes in sleep problems, parents’ distress and impact of sleep problems from infancy to preschool age for referred and unreferred children. Scand J Caring Sci 19:86–94CrossRefGoogle Scholar
  13. 13.
    Alfano CA, Beidel DC, Turner SM, Lewin DS (2006) Preliminary evidence for sleep complaints among children referred for anxiety. Sleep Med 7:467–473. CrossRefGoogle Scholar
  14. 14.
    Alfano CA, Ginsburg GS, Kingery JN (2007) Sleep-related problems among children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry 46:224–232. CrossRefGoogle Scholar
  15. 15.
    Chase RM, Pincus DB (2011) Sleep-related problems in children and adolescents with anxiety disorders. Behav Sleep Med 9:224–236. CrossRefGoogle Scholar
  16. 16.
    Alvaro PK, Roberts RM, Harris JK (2013) A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression. Sleep 36:1059–1068CrossRefGoogle Scholar
  17. 17.
    Gregory AM, O’Connor TG (2002) Sleep problems in childhood: a longitudinal study of developmental change and association with behavioral problems. J Am Acad Child Adolesc Psychiatry 41:964–971CrossRefGoogle Scholar
  18. 18.
    Alfano CA, Zakem AH, Costa NM, Taylor LK, Weems CF (2009) Sleep problems and their relationship to cognitive factors, anxiety, and depressive symptoms in children and adolescents. Depress Anxiety 26:503–512. Google Scholar
  19. 19.
    Riemann D (2007) Insomnia and comorbid psychiatric disorders. Sleep Med 4:S15–S20. CrossRefGoogle Scholar
  20. 20.
    Settipani CA, Puleo CM, Conner BT, Kendall PC (2012) Characteristics and anxiety symptom presentation associated with autism spectrum traits in youth with anxiety disorders. J Anxiety Disord 26:459–467. CrossRefGoogle Scholar
  21. 21.
    Cotton SM, Richdale AL (2006) Brief report: parental descriptions of sleep problems in children with autism, Down syndrome, and Prader–Willi syndrome. Res Dev Disabil 27:151–161CrossRefGoogle Scholar
  22. 22.
    Krakowiak P, Goodlin-Jones B, Hertz-Picciotto I, Croen LA, Hansen RL (2008) Sleep problems in children with autism spectrum disorders, developmental delays, and typical development: a population-based study. J Sleep Res 17:197–206. CrossRefGoogle Scholar
  23. 23.
    Polimeni MA, Richdale AL, Francis AJP (2005) A survey of sleep problems in autism, Asperger’s disorder and typically developing children. J Intellect Disabil Res 49:260–268CrossRefGoogle Scholar
  24. 24.
    Van Steensel FJA, Bögels SM, Perrin S (2011) Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clin Child Fam Psychol Rev 14:302–317CrossRefGoogle Scholar
  25. 25.
    Alfano CA, Gamble AL (2009) The role of sleep in childhood psychiatric disorders. Child Youth Care Forum 38:327–340. CrossRefGoogle Scholar
  26. 26.
    Chorney DB, Detweiler MF, Morris TL, Kuhn BR (2008) The interplay of sleep disturbance, anxiety, and depression in children. J Pediatr Psychol 33:339–348. CrossRefGoogle Scholar
  27. 27.
    Sivertsen B, Posserud M-B, Gillburg C, Lundervold AJ, Hysing M (2012) Sleep problems in children with autism spectrum disorders: a longitudinal population-based study. Autism 16:139–150. CrossRefGoogle Scholar
  28. 28.
    Verhoeff ME, Blanken LME, Kocevska D, Mileva-Seitz VR, Jaddoe VWV, White T, Tiemer H (2018) The bidirectional association between sleep problems and autism spectrum disorder: a population-based cohort study. Mol Autism 9:8. CrossRefGoogle Scholar
  29. 29.
    May T, Cornish K, Conduit R, Rajaratnam SMW, Rinehart NJ (2015) Sleep in high-functioning children with autism: longitudinal developmental change and associations with behavior problems. Behav Sleep Med 13:2–18. CrossRefGoogle Scholar
  30. 30.
    Mazurek MO, Petroski GF (2015) Sleep problems in children with autism spectrum disorder: examining the contributions of sensory over-responsivity and anxiety. Sleep Med 16:270–279. CrossRefGoogle Scholar
  31. 31.
    Rzepecka H, McKenzie K, McClure I, Murphy S (2011) Sleep, anxiety and challenging behaviour in children with intellectual disability and/or autism spectrum disorder. Res Dev Disabil 32:2758–2766. CrossRefGoogle Scholar
  32. 32.
    Lundström S, Chanmg Z, Råstam M, Gillberg C, Larrson H, Anckarsäter H, Lichtenstein P (2012) Autism spectrum disorders and autistic-like traits. Arch Gen Psychiatry 69:46–52CrossRefGoogle Scholar
  33. 33.
    Robinson E, Koenen KC, McCormick MC, Munir K, Hallett V, Happé F, Plomin R, Ronald A (2011) Evidence that autistic traits show the same etiology in the general population and at the quantitative extremes (5%, 2.5% and 1%). Arch Gen Psychiatry 68:1113–1121. CrossRefGoogle Scholar
  34. 34.
    Newnham J, Evans S, Michael C, Stanley F, Landau L (1993) Effects of frequent ultrasound during pregnancy: a randomized controlled trial. Lancet 342:887–891CrossRefGoogle Scholar
  35. 35.
    Achenbach TM (1991) Manual for the Child Behavior Checklist/4-18 and 1991 Profile. University of Vermont, BurlingtonGoogle Scholar
  36. 36.
    Sadeh A, Raviv A, Gruber R (2000) Sleep patterns and sleep disruptions in school-aged children. Dev Psychol 36:291–301.CrossRefGoogle Scholar
  37. 37.
    Ward TM, Rankin S, Lee KA (2007) Caring for children with sleep problems. J Pediatr Nurs 22:283–296. CrossRefGoogle Scholar
  38. 38.
    Mindell JA, Sadeh A, Wiegand B, How TH, Goh DYT (2010) Cross-cultural differences in infant and toddler sleep. Sleep Med 11:274–280. CrossRefGoogle Scholar
  39. 39.
    Sadeh A, Mindell J, Rivera L (2011) “My child has a sleep problem”: a cross-cultural comparison of parental definitions. Sleep Med 12:478–482. CrossRefGoogle Scholar
  40. 40.
    Fergusson DM, Woodward LJ, Horwood J (1998) Maternal smoking during pregnancy and psychiatric adjustment in late adolescence. Arch Gen Psychiatry 55:721–727CrossRefGoogle Scholar
  41. 41.
    Gilliland FD, Yu-Fen L, Peters JM (2001) Effects of maternal smoking during pregnancy and environmental tobacco smoke on asthma and wheezing in children. J Respir Crit Care Med 163:429–436. CrossRefGoogle Scholar
  42. 42.
    Kier C, Hom S, Faiza Q (2012) Asthma and sleep. J Asthma Allergy Educ 3:99–105. CrossRefGoogle Scholar
  43. 43.
    Bramlett MD, Blumberg SJ (2007) Family structure and children’s physical and mental health. Health Aff 26:549–558. CrossRefGoogle Scholar
  44. 44.
    Bender PK, Reinholdt-Dunne ML, Esbjørn BH, Pons F (2012) Emotion dysregulation and anxiety in children and adolescents: gender differences. Pers Individ Differ 53:284–288. CrossRefGoogle Scholar
  45. 45.
    Breslau N, Roth T, Rosenthal L, Andreski P (1996) Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults. Biol Psychiatry 39:411–418CrossRefGoogle Scholar
  46. 46.
    Achenbach TM, Edelbrock C, Howell CT (1987) Empirically based assessment of the behavioral/emotional problems of 2- and 3-year-old children. J Abnorm Child Psychol 15:629–650CrossRefGoogle Scholar
  47. 47.
    American Academy of Sleep Medicine (2014) International classification of sleep disorders, 3rd edn. Author, DarienGoogle Scholar
  48. 48.
    Achenbach TM, Rescorla LA (2000) Manual for the ASEBA preschool forms & profiles. Univeristy of Vermont, BurlingtonGoogle Scholar
  49. 49.
    Achenbach TM, Rescorla LA (2001) Manual for the ASEBA school-age forms & profiles. University of Vermont, BurlingtonGoogle Scholar
  50. 50.
    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DCGoogle Scholar
  51. 51.
    Tabachnick BG, Fidell LS (2013) Using multivariate statistics, 6th edn. Pearson, New JerseyGoogle Scholar
  52. 52.
    Shevlin M, McElroy E, Murphy J (2017) Homotypic and heterotypic psychopathological continuity: a child cohort study. Soc Psychiatry Psychiatr Epidemiol 52:1135–1145. CrossRefGoogle Scholar
  53. 53.
    White SW, Oswald D, Ollendick T, Scahill L (2009) Anxiety in children and adolescents with autism spectrum disorders. Clin Psychol Rev 29:216–229. CrossRefGoogle Scholar
  54. 54.
    American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. Am Psychiatr Publ, ArlingtonCrossRefGoogle Scholar
  55. 55.
    Muris P, Steerneman P, Merckelbach H, Holdrinet I, Meesters C (1998) Comorbid anxiety symptoms in children with pervasive developmental disorders. J Anxiety Disord 12:387–393CrossRefGoogle Scholar
  56. 56.
    Hudson JL, Dodd HF (2012) Informing early intervention: preschool predictors of anxiety disorders in middle childhood. Plos ONE 7(8):E42359CrossRefGoogle Scholar
  57. 57.
    Wichstrom L, Belsky J, Berg-Nielsen TS (2013) Preschool predictors of childhood anxiety disorders: a prospective community study. J Child Psychol Psychiatry 54:1327–1336. CrossRefGoogle Scholar
  58. 58.
    Simard V, Nielsen TA, Tremblay RE, Boivin M, Montplaisir JY (2008) Longitudinal study of preschool sleep disturbance. Arch Pediatr Adolesc Med 162:360–367. CrossRefGoogle Scholar
  59. 59.
    Niemyczk J, Wagner C, von Gontard A (2017) Incontinence in autism spectrum disorder: a systematic review. Eur Child Adolesc Psychiatry. Google Scholar
  60. 60.
    Richdale A, Schreck KA (2009) Sleep problems in autism spectrum disorders: prevalence, nature, & possible biopsychosocial aetiologies. Sleep Med Rev 13:403–411. CrossRefGoogle Scholar
  61. 61.
    Johnson EO, Roth T, Breslau N (2006) The association of insomnia with anxiety disorders and depression: exploration of the direction of risk. J Psychiatr Res 40:700–708. CrossRefGoogle Scholar
  62. 62.
    Gregory AM, Cousins JC, Forbes EE, Trubnick L, Ryan ND, Axelson DA, Dahl RE (2011) Sleep items in the child behavior checklist: a comparison with sleep diaries, actigraphy, and polysomnography. J Am Acad Child Adolesc Psychiatry 50:499–507. CrossRefGoogle Scholar
  63. 63.
    Field A (2013) Discovering statistics using IBM SPSS statistics, 4th edn. Sage, LondonGoogle Scholar
  64. 64.
    Paavonen EJ, Aronen ET, Moilanen I, Piha J, Rasanen E, Tamminen T, Almqvist F (2000) Sleep problems of school-aged children: a complimentary view. Acta Paediatr 89:223–238CrossRefGoogle Scholar
  65. 65.
    Richdale AL, Baglin CL (2015) Self-report and caregiver-report of sleep and psychopathology in children with high-functioning autism spectrum disorder: a pilot study. Dev Neurorehabil 18:272–279CrossRefGoogle Scholar
  66. 66.
    McMakin DL, Alfano CA (2015) Sleep and anxiety in late childhood and early adolescence. Curr Opin Psychiatry 28:483–489. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Orygen, The National Centre of Excellence in Youth Mental HealthMelbourneAustralia
  2. 2.Centre for Youth Mental HealthThe University of MelbourneMelbourneAustralia
  3. 3.Olga Tennison Autism Research Centre, School of Psychology and Public HealthLa Trobe UniversityMelbourneAustralia
  4. 4.Telethon Kids Institute, University of Western AustraliaSubiacoAustralia

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