Association of sleep with emotional and behavioral problems among abused children and adolescents admitted to residential care facilities in Japan

<div><p>Background</p><p>The psychological care of abused children in the child protection system is an urgent issue in Japan. Child abuse has a serious impact on children’s emotion and behavior, but there is virtually no evidence about how child abuse affects sleep, which is closely related to behavioral and emotional control. In this study, we sought to identify sleep habits and suspected sleep disorders among abused children and adolescents admitted to residential care facilities in Japan and to investigate their association with emotional and behavioral problems.</p><p>Methods</p><p>The study targeted 273 abused children and adolescents (age range: 4 to 15 years) who had been admitted to a residential care facility in Japan. They were assessed by physicians and other personnel at facilities with expertise in childcare and abuse. Respondents completed a brief sleep questionnaire on the incidence of problematic sleep habits and suspected sleep disorders as well as a questionnaire on emotional and behavioral issues.</p><p>Results</p><p>Approximately 40% of the abused children and adolescents had some sleep-related symptoms at bedtime and waking, and 19% had suspected sleep disorder. Abused children with emotional and behavioral problems had a significantly higher incidence of suspected sleep disorders than abused children without such problems, and this incidence was particularly high among those with antisocial behavior and depressive behavior. Our predictive model also showed that antisocial behavior and depressive behavior were significant predictors of suspected sleep disorders.</p><p>Conclusion</p><p>Careful assessment and appropriate therapeutic intervention for sleep disorders are required in abused children and adolescents with emotional and behavioral problems.</p></div

Correlation coefficients between psychological assessments and subjective ratings (“risky” and “anxiety”) about the actions in video clips.

<p><b>Bold type</b>*: <i>p</i><0.05.</p

Neural activity for Suppress-negative (A) and Observe-negative (B) contrasted with Look-negative (<i>p</i> < .001 uncorrected).

<p>Regions with significantly greater activation in Suppress-negative compared to Look-negative condition included the left inferior frontal gyrus (IFG; BA47). During Observe-negative compared to Look-negative, there was greater activation in the precentral gyrus (BA6), IFG (BA44), superior frontal gyrus (SFG; BA6/8), middle temporal gyrus (MTG; BA21/22), inferior parietal lobule (IPL; BA40), putamen, and anterior insula (AI; BA13).</p

Neural Networks for Mindfulness and Emotion Suppression

<div><p>Mindfulness, an attentive non-judgmental focus on “here and now” experiences, has been incorporated into various cognitive behavioral therapy approaches and beneficial effects have been demonstrated. Recently, mindfulness has also been identified as a potentially effective emotion regulation strategy. On the other hand, emotion suppression, which refers to trying to avoid or escape from experiencing and being aware of one’s own emotions, has been identified as a potentially maladaptive strategy. Previous studies suggest that both strategies can decrease affective responses to emotional stimuli. They would, however, be expected to provide regulation through different top-down modulation systems. The present study was aimed at elucidating the different neural systems underlying emotion regulation via mindfulness and emotion suppression approaches. Twenty-one healthy participants used the two types of strategy in response to emotional visual stimuli while functional magnetic resonance imaging was conducted. Both strategies attenuated amygdala responses to emotional triggers, but the pathways to regulation differed across the two. A mindful approach appears to regulate amygdala functioning via functional connectivity from the medial prefrontal cortex, while suppression uses connectivity with other regions, including the dorsolateral prefrontal cortex. Thus, the two types of emotion regulation recruit different top-down modulation processes localized at prefrontal areas. These different pathways are discussed.</p></div

Experimental conditions and Visual Analog Scale (VAS) score (100-0) for each condition.

<p>Data are presented as mean ± standard deviation.</p

Coordinates for the brain areas activated in Suppress-negative vs. Look-negative.

<p>Height threshold: <i>p</i> < .001 uncorrected, Extent threshold: <i>k</i> = 5 voxels. The x, y, and z coordinates by which a voxel is determined referring to medial–lateral (x: positive = right), anterior–posterior (y: positive = anterior), and superior–inferior (z: positive = superior) positions denote the peak location on the MNI template. T-scores denote the difference between the two sample means compared with the dispersion and sample sizes of the two samples.Z-scores are the numbers from the unit normal distribution that give the same p value as the t statistic. Abbreviations: BA = Brodmann area; MNI = Montreal Neurological Institute template.</p><p>Coordinates for the brain areas activated in Suppress-negative vs. Look-negative.</p

(A) Scatterplots of associations between insula activity (BA13, peak in MNI space: −40 −10 20) and age for the peak of the clusters surviving conjunction analysis with an independent regression of extraversion.

<p>Left panel: association between age and insula activity (<i>r</i> = 0.60, <i>p</i><0.01). Right panel: association between extraversion and insula activity (<i>r</i> = 0.61, <i>p</i><0.01). (B) Brain regions that mediated the relationship between age and extraversion. Parameter estimates (risk-taking > safe contrast) extracted at the region identified by conjunction analyses were independently regressed by age and psychological properties. Mediation tests were based on methods described by Shrout and Bolger (2002) and Baron and Kenny (1986). (a) Regression slope of age predicting neural activity; (b) regression slope of neural activity predicting extraversion, controlling for age; (c) regression slope of age predicting extraversion; (c’) regression slope of age predicting extraversion, controlling for neural activity. Bootstrapping was used to estimate indirect effects (Shrout & Bolger, 2002; see also Preacher & Hayes, 2004). A confidence interval that does not overlap with zero indicates statistically significant mediation. *Indicates significant difference from zero, <i>p</i><0.05. Coordinates are given in MNI space.</p

Coordinates of the brain areas activated in Observe-negative vs. Look-negative.

<p>Height threshold: <i>p</i> < .001 uncorrected, Extent threshold: <i>k</i> = 5 voxels. The x, y, and z coordinates by which a voxel is determined referring to medial–lateral (x: positive = right), anterior–posterior (y: positive = anterior), and superior–inferior (z: positive = superior) positions denote the peak location on the MNI template. T-scores denote the difference between the two sample means compared with the dispersion and sample sizes of the two samples. Z-scores are the numbers from the unit normal distribution that give the same p value as the t statistic. Abbreviations: BA = Brodmann area; MNI = Montreal Neurological Institute template.</p><p>Coordinates of the brain areas activated in Observe-negative vs. Look-negative.</p

Coordinates of the brain areas whose connectivity with the amygdala was positively correlated with regional amygdala activity during Suppress-negative vs. Look-negative.

<p>Height threshold: <i>p</i> < .001 uncorrected, Extent threshold: <i>k</i> = 5 voxels. The x, y, and z coordinates by which a voxel is determined referring to medial–lateral (x: positive = right), anterior–posterior (y: positive = anterior), and superior–inferior (z: positive = superior) positions denote the peak location on the MNI template. T-scores denote the difference between the two sample means compared with the dispersion and sample sizes of the two samples. Z-scores are the numbers from the unit normal distribution that give the same p value as the t statistic. Abbreviations: BA = Brodmann area; MNI = Montreal Neurological Institute template.</p><p>Coordinates of the brain areas whose connectivity with the amygdala was positively correlated with regional amygdala activity during Suppress-negative vs. Look-negative.</p

Sleep habits and incidence of sleep-related symptoms and sleep disorders by presence/absence of emotional and behavioral problems in abused children.

<p>Sleep habits and incidence of sleep-related symptoms and sleep disorders by presence/absence of emotional and behavioral problems in abused children.</p