The Journal of Primary Prevention

, Volume 40, Issue 2, pp 231–241 | Cite as

Linking Sleep to Externalizing Behavioral Difficulties: A Longitudinal Psychometric Survey in a Cohort of Italian School-Age Children

  • Pietro MuratoriEmail author
  • Danilo Menicucci
  • Elisa Lai
  • Floriana Battaglia
  • Lucio Bontempelli
  • Natasha Chericoni
  • Angelo Gemignani
Original Paper


We examined the longitudinal relationship between sleep problems and behavioral problems at primary school in Italian children. We recruited a school-based sample of 227 children (age range 6–10 years) in schools located in Pisa (Italy). Parents completed the Sleep Disturbance Scale for Children (SDSC), and teachers completed the Strengths and Difficulties Questionnaire (SDQ) to evaluate children’s behavioral difficulties. We used a two-step robust regression approach to identify which aspects of sleep problems might affect children’s behavior at school. After removing socio-demographic effects, results indicated an association between an increase in sleep problems and the worsening of inattentive and hyperactive behavioral problems at school 1 year later. This association was particularly robust in children whose sleep problems had gotten worse over the year. We found no associations between child sleep problems and conduct problems in school settings. Schools may be a suitable arena in which to identify and prevent the development of severe externalizing behaviors through screening procedures and intervention for children’s sleep problems.


Sleep problems School Hyperactivity Conduct problems Prevention 



We are grateful for the close collaboration with the Tongiorgi Public Schools, Pisa, Italy. We greatly appreciate the hard work and dedication of the many staff members and students (Giulia Burgalassi, Giuditta Tinti, Elena Guarguagli, Giulia Borgiani, Sara Paoletti, and Francesca Vacca) who collected the evaluation data.

Compliance With Ethical Standards

Conflict of Interest

Danilo Menicucci was funded by the University of Pisa, the ECSPLAIN-FP7 IDEAS-ERC ref.338866. Other authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.IRCCS Fondazione Stella MarisPisaItaly
  2. 2.Department of Translational Research on New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
  3. 3.Medicina Clinica e SperimentaleUniversità di PisaPisaItaly
  4. 4.Istituto Comprensivo M.L.KingMIURCalcinaia (PI)Italy
  5. 5.Istituto Comprensivo TongiorgiMIURPisaItaly
  6. 6.Dipartimento di Patologia Chirurgica, Medica, Molecolare et dell’Area CriticaUniversità degli Studi PisaPisaItaly
  7. 7.Azienda Ospedaliero UniversitariaPisaItaly

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