Sleep difficulties in children exposed to trauma

In 2012, the blog weekly features a summary or discussion of a recent scientific article on traumatic stress in children.

This week a summary of Hall Brown et al. (Oct 2011) on sleep in children after Hurricane Katrina.


In childhood it is normal to have some nighttime fears. Most children outgrow them. However, when fears continue to exist, they endanger sleep quality and daily functioning. One situation in which this may happen, is after traumatic exposure.

We know that adult mental health problems and sleep difficulties are related after trauma but we have only very limited data on children. Therefore, Hall Brown and colleagues studied the role of sleep problems in the maintenance of posttraumatic stress symptoms in youths who experienced Hurricane Katrina.

The study: The sample consisted of 191 children and adolescents in New Orleans who had complete data for Time 1 (24 months post-Katrina) and Time 2 (30 months post-Katrina). The children were between 8 and 15 years old, mostly African American, with boys accounting for 55% of the sample. The youths came from a neighborhood that had encountered massive damage. For example, many children reported having thought that someone might die in the hurricane, that their homes were badly damaged, that they witnessed someone else being hurt, or that they had a pet hurt or die.

The study used self-report questionnaires. The children filled out the Posttraumatic Stress Reaction Index for children (PTSD-RI, by Frederick et al., 1992) and a measure to assess the exposure to the hurricane and its aftermath (La Greca et al. 1998). Sleep disturbance and fear of sleeping alone were assessed via two  items of the Revised Child Anxiety and Depression Scales (RCADS, Chorpita et al., 2000): “Having trouble sleeping” and “I feel scared if I have to sleep on my own”. The analyses consisted of t tests and multivariate linear regression models.

What did they find? Two fifths of the sample had moderate to very severe symptoms of posttraumatic stress. An important number of children reported sleep disturbance (46% and 50% at T1 and T2 respectively), while a somewhat smaller number reported fear of sleeping alone (25% and 16%). Children with sleep disturbance or fear of sleeping alone reported more posttraumatic stress symptoms than children who did not report sleep problems. General sleep disturbance at T1 predicted posttraumatic stress at T2, also after controlling for age, gender, continued home  damage, and posttraumatic stress at T1. This was not the case for fear of sleeping alone: this item did not have predictive power left when the other variables were introduced in the model.

What to conclude? The authors suggest that sleep disturbances are common in the aftermath of childhood trauma and persist for an important number of children. Because sleep problems can result in fatigue and irritability, they may interfere with processes that otherwise contribute to recovery. The authors argue that more research is needed into strategies to reduce sleep difficulties after trauma. One avenue to address the problem may be cognitive behavioral therapy (CBT).

Limitations of the study: the authors used two one-item questions to measure sleep problems while this would ideally be a set of questions, the data were self-reported, and they did not have the chance to identify sleep problems in the sample prior to Katrina.
Brown, T., Mellman, T., Alfano, C., & Weems, C. (2011). Sleep fears, sleep disturbance, and PTSD symptoms in minority youth exposed to Hurricane Katrina Journal of Traumatic Stress, 24 (5), 575-580 DOI: 10.1002/jts.20680

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