Research reportEarly childhood sleep and eating problems as predictors of adolescent and adult mood and anxiety disorders
Introduction
Mood and anxiety disorders are debilitating psychiatric conditions often requiring long-term treatment and monitoring, with the first onset often occurring in childhood and adolescence. With no known biological markers available to diagnose mood and anxiety disorders, the use of behavioral signs that occur during early childhood to predict subsequent psychopathology could be useful. Extensive research has been conducted to study the risk for adult internalizing problems and symptoms based on adolescent symptomatology (Pine et al., 1998) and childhood neurological soft signs (Shaffer et al., 1985, Pine et al., 1993), including somatic illnesses and health problems during early childhood (Jacobsen et al., 1983, Wells et al., 1985, Cohen et al., 1989, Katon and Sullivan, 1990). However, health problems during childhood may go undetected by parents and sometimes even by clinicians, so the search for readily observable and reportable signs as possible identified risk factors is warranted.
Parents are usually knowledgeable about their children's sleep and eating habits, and are thus more likely to notice and complain about any irregularities of daily living routines and their related difficulties. Children on the other hand are poor reporters of appetite problems and to a lesser extent, sleep difficulties (Waters and Storm, 1985). Sleep problems during childhood have generated a reasonable amount of interest in child psychiatry as it has been implicated in several childhood psychopathologies, including anxiety/depression (Ryan et al., 1987, Johnson et al., 2000), attention problems (Dahl et al., 1991, Yuen et al, 1999, Gruber et al., 2000), hyperactivity and conduct problems (Dahl, 1996, Aronen et al., 2000). In a longitudinal study by Gregory and O'Connor (2002) on 490 children, parental reports of sleep problems at age 4 predicted behavioral/emotional problems in mid-adolescence. Similarly, motor activity (measured using objective measurements such as actigraphy or polysomnography) and its influence on childhood psychopathologies, have been studied in children and adolescents with nonseasonal depression (Teicher et al., 1993), major depressive disorder (Armitage et al., 2004), and ADHD (Small et al., 1971, Busby et al., 1981, Porrino et al., 1983, Tirosh et al., 1993). Pediatric sleep-related involuntary movements, identified through sleep questionnaires completed by parents, have been associated with both ADHD and to a greater extent, separation anxiety (Corkum et al., 1999). These studies however measure motor movements of children with existing psychiatric conditions and not premorbid sleep motor disturbances. The presence of sleep disturbances could consequently confer an increased risk for new incidences of psychiatric disorders in children and later in their life. To our knowledge, no studies have yet linked high motor activity during sleep in early childhood with lifetime psychiatric diagnoses. In addition, few studies had specifically looked into sleep and eating habits, both of which constitute part of a more observable and enduring host of temperamental traits during early childhood, that may persist over time and ultimately serve as risk factors for later psychopathology.
Available studies on pediatric sleep and eating disturbances and the correlation with psychiatric diagnoses often were based on shorter follow up periods ending in late childhood or mid-adolescence (Stoléru et al., 1997, Gregory and O'Connor, 2002, Gregory et al., 2004) except for one study (Gregory et al., 2005) which followed up very young children up to young adulthood. The pathological significance of the relationship between early childhood behaviors and adolescent and adult psychiatric diagnoses thus remains interesting. In our study, we hypothesized that those children with early sleep and eating irregularities (low rhythmicity), and high motor activity during sleep are at a higher risk of developing lifetime diagnoses for Major Depressive Disorder (MDD), Dysthymic Disorder (DD) or Anxiety Disorder (ANX) than children without the reported problems. The opportunity to study this relationship arose in our earlier longitudinal study of offspring from high-risk families followed up over 20 years.
The specific questions we propose to address in this study are:
- (1)
Is there an association between early childhood low rhythmicity and high motor activity during sleep with lifetime MDD/DD/ANX?
- (2)
What is the relationship between early childhood low rhythmicity and high motor activity during sleep with age of onset of MDD/DD/ANX?
- (3)
Is there a difference in the rates of maternal reporting of offspring sleep and eating problems in the high and low risk groups?
Section snippets
Design
This study is derived from a multi-generational high-risk study. In the original study, adult probands with moderate to severe MDD were selected from outpatient clinical specialty settings for the psychopharmacologic treatment of mood disorders. Non-depressed adult probands were also selected, at the same time, from an epidemiologic sample of adults from the same community. They were required to have no lifetime history of psychiatric illness based on several interviews. See Weissman et al.,
Demographic profile of proband
Of the 74 probands, 51 parents were in the depressed (high-risk) group and 23 were in the non-depressed (low-risk) group. The parent groups did not vary at the beginning of the study by age (mean age, 39.6 ± 7.7 years), sex (56.8% female), marital status (79.7% married), occupation (97.3% skilled worker and above) and educational level attained (93.3% high school and above).
Age and gender of offspring by proband group
Of the 164 offspring from the 74 probands in the study, there were 108 children from the depressed probands and 56 children
Discussion
Our study findings suggest that specific early childhood sleeping and eating behaviors may be predictive of childhood and adolescent-onset mood and anxiety disorders but not adult-onset mood and anxiety disorders. Specifically, low sleep rhythmicity was predictive of both adolescent-onset MDD and ANX while high motor activity during sleep was predictive of childhood and adolescent-onset DD. Low eating rhythmicity, on the other hand, was predictive of childhood-onset ANX. The lack of association
Acknowledgements
This work was supported in part by NIMH grant R01 MH036197 (Dr. Weissman). The first author is also grateful to the National Healthcare Group (Singapore) for funding his research fellowship in New York State Psychiatric Institute/Columbia University under its Health Manpower Development Plan (HMDP), 2004.
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