Associations Between Sleep Health and Child Behavior at Age 6 Years in the INSIGHT Study.

Only 143 of the original 279 children had all the data needed, and anyone missing either the actigraphy or the behavioural tasks was dropped, so the results describe this subset rather than the whole INSIGHT sample. The children were 95% white, 70.7% came from households earning more than $75,000, and all the mothers were English-speaking and recruited from one hospital; the authors say this cannot be generalised to other populations. Sleep and behaviour were measured at the same time point, so the study cannot show whether irregular sleep leads to behaviour problems or the other way round, or how long any link lasts. Actigraphy covered only 7 days, so weekday and weekend sleep could not be looked at separately, and sleep and behaviour were collected in different months of the year. Behaviour was observed in the clinic during two short tasks, so it may not reflect how the child behaves at home. A large number of models were run with no adjustment for multiple comparisons, and the authors describe the analysis as exploratory. The emotion regulation scale used in the transparent box task was developed by the study team rather than being an established measure. No measure of bedtime routines, household chaos or parents' own sleep was collected, so the link the authors draw between sleep variability and routine is not directly tested here.

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Do not read this as evidence that changing a child's sleep will change their behaviour. The sleep and behaviour data were collected at the same point in time, so the study cannot say which came first, and the link between variable sleep onset and emotion regulation was seen only in the home safety control group, not in children who received the parenting intervention.