Sleep problems have been estimated to affect up to 2 in 5 children during the elementary school years and are associated with a range of poorer child health and education outcomes as well as parent outcomes.
1 One common association demonstrated in cross-sectional and longitudinal studies is the link between child sleep problems and behavioral difficulties, such as internalizing and externalizing difficulties.
2 However, the directionality of this association over time and whether there are differences based on the type of behavioral difficulties that children may experience are poorly understood. Addressing this knowledge gap will provide valuable information to inform the focus and timing of interventions aiming to improve children’s sleep and behavior during the elementary school years.