Association of eveningness with problem behavior in children: a mediating role of impaired sleep.

Eveningness, the preference of being active during the evening in contrast to the morning, has been associated with markedly increased problem behavior in adolescents; however, the underlying mechanisms are still not understood. This study investigates the association of eveningness with behavior and cognition in children aged 7-12 yrs, and explores the potential mediating role of a variety of sleep factors. Parents of 333 school-aged children (mean age=9.97 yrs; 55% girls) completed a sleep log and several questionnaires regarding eveningness, sleep habits, and behavioral problems. Intellectual abilities, working memory, and attention were assessed using the short-form of the Wechsler Intelligence Scale for Children (WISC) and subtasks of the Amsterdam Neuropsychological Tasks. Results showed that eveningness predicted behavioral problems over and above the effects of demographic variables (age, sex, and familial socioeconomic status) (p=0.003). Significant partial correlation was found for eveningness and sleep duration during weekdays (p=0.005), and not during weekends. Furthermore, evening orientation was associated with a reduced rested feeling on weekday mornings (p<0.001), but not on weekends. The most important sleep characteristic showing association with many cognitive and behavioral measures was the subjective feeling upon awakening-particularly during weekdays. Bootstrap mediation analyses demonstrated that sleep significantly mediated the effects of eveningness on behavioral problems, working memory, and sustained attention. Interestingly, mediation was only significant through the subjective feeling upon awakening on weekdays. The current findings indicate that the subjective feeling upon awakening is a much better predictor of daytime problems than subjective sleep quantity. Furthermore, the data suggest that negative outcomes in evening types are due to the fact that they wake up before their circadian drive for arousal and prior to complete dissipation of sleep pressure during weekdays. Interventions that target the misalignment of endogenous circadian rhythms and imposed rhythms are discussed.