Sleep and poverty
By Joseph A. Buckhalt and Mona El-Sheikh
Childhood and adolescence is a period when life-long trajectories can be influenced for better or worse. Much concern in the U.S. has long been expressed about how poverty affects developing children, and with child poverty rates soaring, concerns have been heightening. Researchers and public policy makers have sought to understand the mechanisms through which poverty affects children negatively, in the hope that policies and programs to mitigate those effects can be implemented. For example, recognition of importance of early education led to the creation of one of the most enduring and successful anti-poverty programs in the U.S., Project Head Start. Success in school continues to be seen as a way of lifting children out of poverty, and much research has done to determine how to maximize success. A policy report from the Educational Testing Service described over a dozen different factors associated with low school performance that have been studied extensively and tried with varying degrees of success (Barton, 2003).
A new direction has arisen recently that suggests a new dimension to our understanding of problems that impede academic achievement. Children from low SES families have been found to have poor sleep, characterized by shorter duration, poor quality, greater variability and greater incidence of clinical sleep disorders. Findings from many labs across the U.S and abroad have linked poor sleep to compromised cognitive processing, lower academic achievement and maladaptive school behavior. In our own lab, we have followed several cohorts of lower and middle SES children for several years, measuring their sleep and tracking numerous biopsychosocial outcomes. Among our findings are:
- Social class moderated the link between children’s sleep and cognitive functioning on standardized ability tests. Children of middle and lower class had similar performance when sleep was optimal, but when sleep was poor, lower SES children’s cognitive performance suffered (Buckhalt, El-Sheikh, & Keller, 2007).
- Not only were these effects present in cross-sectional studies, but poor sleep in our initial assessments was related to academic outcomes two years later (Buckhalt, El-Sheikh, Keller, & Kelly, 2009).
- Emotional and behavior problems also affect school success. Children who did not sleep well had more internalizing and externalizing behavior problems two years later, and lower SES children were at greatest risk (El-Sheikh, Kelly, Buckhalt, & Hinnant, 2010).
- We have discovered some of the mechanisms through which SES has these effects. Parental depression and family conflict are two of these. Parental depression was associated with poorer children’s sleep, and both interparental and parent-child conflict were pathways of risk in that association (El-Sheikh, Bagley, Kelly & Wetter, 2012).
- Relations between sleep and many outcomes are reciprocal. Not only did marital conflict predict poor sleep, but children’s sleep disruptions were predictive of marital conflict two years later (Kelly & El-Sheikh, 2011).
These results and those of our colleagues in developmental sleep research are leading to examination of a wide number of sociocultural processes as they relate to sleep in childhood and how sleep in turn relates to a wide array of important and damaging outcomes that influence trajectories of achievement, life success and health. Many of these are discussed in chapters of Sleep and Development: Familial and Sociocultural Considerations (El-Sheikh, 2011).
Children’s sleep health has become a new focus for prevention and intervention. A small percentage of children have diagnosed or undiagnosed clinical sleep disorders (Mindell & Owens, 2010). Better screening in schools and pediatric clinics would lead to early detection, prevention and treatment. Adenotonsillectomy has been shown improving both sleep and cognitive performance from some children (Chervin et al., 2006). Oral appliances and CPAP treatment for snoring and sleep apnea and behavior management for problems such as insomnia have also been successful (Mindell & Owens, 2010). But a far greater number of children have sleep problems that do not rise to a clinical level, yet are serious enough to impair health and performance over a long period. For these children, interventions directed toward the physical and psychosocial environment of sleep are called for. Clean, comfortable bedding, adequate heating and cooling, and reduction of airborne toxins (e.g. tobacco smoke; allergens) all facilitate good sleep. In the psychosocial realm, parental management of bedtimes, monitoring of caffeine, restricting media use, noise abatement and reducing precipitators of anxiety (e.g. family conflict), are all ways to improve sleep.
Making improvements in children’s sleep will not be easy, as efforts to improve nutrition and exercise habits have shown. But the risks and costs of not doing so are becoming more and more evident, as patterns of poor sleep established in childhood and adolescence endure into adulthood with serious consequences for health and well-being. The next article, by Karen Matthews, will summarize some of those ultimate consequences.
Barton, P.E. (2003). Parsing the achievement gap: Baselines for tracking progress (PDF, 519KB). Princeton, N.J.: Educational Testing Service. http://www.ets.org/Media/Research/pdf/PICPARSING.pdf
Buckhalt, J.A., El-Sheikh, M, & Keller. P. (2007) Children’s sleep and cognitive functioning: Race and socioeconomic status as moderators of effects. Child Development, 78, 213-231
Buckhalt, J.A., El-Sheikh, M, Keller. P., & Kelley, R. (2009). Concurrent and longitudinal relations between children’s sleep and cognitive functioning. Child Development, 80, 875-892.
Chervin, R.D., Ruzicka, D.L., Giordani, B.J., Weatherley, R.A., Dillon, J.E., Hodges, E.K., Marcus, C.L., & Guire, K.E. (2006). Sleep-disordered breathing, behavior, and cognition in children before and \ after adenotonsillectomy. Pediatrics, 117, e769-778. (doi: 10.1542/peds.2005-1837)
El-Sheikh, M. (Ed.). Sleep and development: Familial and socio-cultural considerations. New York: Oxford University Press
El-Sheikh, M., Bagley, E. J., Kelly, R., & Wetter, E.K. Parental depressive symptoms and children’s sleep: the role of family conflict. Journal of Child Psychology and Psychiatry, 53, 806-814.
El-Sheikh, M., Kelly, R., Buckhalt, J.A. & Hinnant, J. (2010). Children's sleep and adjustment over time: The role of the socio-economic context. Child Development, 81, 870-883
Kelly, R. & El-Sheikh, M. (2011). Marital conflict and children's sleep: Reciprocal relations and socioeconomic effects. Journal of Family Psychology, 25, 412-422.
Mindell, J.A. & Owens, J.A. (2011). A Clinical guide to pediatric sleep: Diagnosis and management of sleep problems. Philadelphia: Lippincott, Williams, & Wilkins.
Joseph A. Buckhalt, PhD, is the Wayne T. Smith distinguished professor in the department of special education, rehabilitation and counseling at Auburn University.
Mona El-Sheikh, PhD, is the Leonard Petersen & Co., Inc. professor in the department of human development and family studies at Auburn University.
Their collaborative work concentrates on children at risk for behavioral and emotional problems, health problems and academic underachievement. Working from a biopsychosocial model, their research has explicated how sleep functions as a risk or protective factor for the development of problems over the course of childhood and adolescence. Their studies have led to better understanding of how physiological systems (e.g. autonomic nervous system) are related to sleep health, and how various parameters of objectively measured sleep are linked to child outcomes. A central focus has been to assess sleep in children from families varying widely in social class, and they have proposed that sleep may be a conduit through which some of the more commonly understood stressors associated with poverty have their effect on outcomes.