Sleep and School Functioning: Guidelines for Assessment and Intervention

By Laracy, Seth D.; Ridgard, Tamique J. et al. | National Association of School Psychologists. Communique, June 1, 2015 | Go to article overview

Sleep and School Functioning: Guidelines for Assessment and Intervention


Laracy, Seth D., Ridgard, Tamique J., Dupaul, George J., National Association of School Psychologists. Communique


Sleep is critical to students' functioning at school. School psychologists can effectively assess sleep habits in only a few minutes, and can often improve students' sleep with brief interventions. This article reviews the importance of sleep and provides school psychologists with strategies for assessment and intervention. This article also provides a brief discussion of several sleep disorders (e.g., obstructive sleep apnea, parasomnias, restless legs syndrome, narcolepsy) that may require referral to a medical provider.

WHY IS SLEEP IMPORTANT?

Sleep is an important consideration for school psychologists because sleep difficulties are relatively common and may affect students' academic and psychosocial functioning. As much as 25% of children experience some sleep difficulty (Owens, 2007), and more than 5% of children experience difficulty that is notable enough that a primary care provider has provided sleep treatment recommendations (Meitzer, Plaufcan, Thomas, & Mindel, 2014). The prevalence of sleep difficulty is even higher for children with certain medical conditions (e.g., pain, asthma, traumatic brain injury) or psychiatric disorders (e.g., attention deficit hyperactivity disorder, autism spectrum disorder, depression, anxiety).

Insufficient sleep is associated with impairment across a range of functional domains. Sleep duration accounts for as much as 64% of the variance in cognitive processes that are essential to academic functioning, including working memory, short-term memory, and attention (Steenari et al, 2003; Vriend et al, 2013). Not surprisingly, decreased sleep is associated with poorer declarative and procedural learning, and decreased sleep quantity and quality are associated with poorer academic performance (Curcio, Ferrara, & De Gennaro, 2006). The effects of poor sleep are also felt in the realm of behavioral and emotional functioning. Shifting children's bedtimes later by only 1 hour has been asso- ciated with fewer positive emotions and poorer parent-reported emotional regulation after only 4 days (Vriend et al., 2013). Insufficient sleep in children has also been associated with higher rates of aggression, depressive symptoms, and externalizing behavior problems, and lower ratings of self-esteem, emotional/mental health, and life satisfaction (Fredriksen, Rhodes, Reddy, & Way, 2004; Gregory, Van der Ende, Willis, & Verhulst, 2008; Roberts, Roberts, 8c Duong, 2008; Stein, Mendelsohn, Obermeyer, Amromin, & Benca, 2001). Additionally, lack of sleep can negatively affect interpersonal relationships with family, friends, and peers (Roberts et al., 2008).

ASSESSMENT OF SLEEP

The clear relationship between sleep and academic, cognitive, behavioral, and emotional functioning suggests that sleep should be considered in the assessment of all children with suspected learning, behavioral, or emotional disorders. With all of the variables that are related to academic performance and behavior at school, a school psychologist's assessment of sleep often needs to be brief and focused on the variables most likely to affect school functioning. Given the relationship between daytime sleepiness and academic outcomes, students, parents, and teachers should be asked about the presence and severity of excessive daytime sleepiness. School psychologists should keep in mind that excessive sleepiness may present as tiredness, irritability, or hyperactivity in young children.

Because the most likely cause of excessive daytime sleepiness among school-age children is insufficient sleep (Meitzer & Mindell, 2006), the major focus of sleep assessment should be on factors related to the quantity of sleep a child receives. A good understanding of sleep habits can be obtained with a few questions about the routine that leads up to bedtime, the time a child gets into bed, the sleep environment (e.g., television in the bedroom, sleeping independently versus with a parent or sibling), the child's behavior at bedtime (e. …

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