title: Behavioral symptoms and sleep problems in children with anxiety disorder.
abstract: BACKGROUND
  Sleep disorders are frequently associated with childhood behavioral problems and mental illnesses such as anxiety disorder. To identify promising behavioral targets for pediatric anxiety disorder therapy, we investigated the associations between specific sleep and behavioral problems.
  
  
  METHODS
  We conducted retrospective reviews of 105 patients aged 4-12 years who met the DSM-IV criteria for primary diagnosis of generalized anxiety disorder (n = 33), separation anxiety disorder (n = 23), social phobia (n = 21), or obsessive compulsive disorder (n = 28). Sleep problems were evaluated using the Children's Sleep Habits Questionnaire (CSHQ) and behavioral problems by the Spence Children's Anxiety Scale, Oppositional Defiant Behavior Inventory (ODBI), and Depression Self-Rating Scale for Children.
  
  
  RESULTS
  Depressive behavior was weakly correlated with CSHQ subscores for sleep onset delay and night waking but not with total sleep disturbance. Anxiety was correlated with bedtime resistance, night waking, and total sleep disturbance score. Oppositional defiance was correlated with bedtime resistance, daytime sleepiness, sleep onset delay, and most strongly with total sleep disturbance. On multiple regression analysis ODBI score had the strongest positive association with total sleep disturbance and the strongest negative association with total sleep duration.
  
  
  CONCLUSIONS
  Sleep problems in children with anxiety disorders are closely related to anxiety and oppositional defiant symptoms.
authors.affiliation: Department of Child and Adolescent Psychiatry, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Iwadare
authors.affiliation: Department of Clinical Laboratory, National Center Hopsital, National Center of Neurology and Psychiatry, Kodaira, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kamei
authors.affiliation: Department of Child and Adolescent Psychiatry, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Usami
authors.affiliation: Department of Child and Adolescent Psychiatry, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Japan.
authors.forename: Hirokage
authors.initials: H
authors.lastname: Ushijima
authors.affiliation: Department of Child and Adolescent Psychiatry, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Department of Child and Adolescent Psychiatry, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Japan.
authors.forename: Kyota
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Child and Adolescent Psychiatry, Aiiku Hospital, Minato, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kodaira
authors.affiliation: Department of Child and Adolescent Psychiatry, Aiiku Hospital, Minato, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Saito
mesh_terms: D001008:Anxiety Disorders / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D001526:Behavioral Symptoms / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D012890:Sleep / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires
keywords: Children's Sleep Habits Questionnaire; anxiety disorder; child; oppositional defiance; sleep