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Sleep, cognition, and behavioral problems in school-age children: A century of research meta-analyzed.
Abstract
Clear associations of sleep, cognitive performance, and behavioral problems have been demonstrated in meta-analyses of studies in adults. This meta-analysis is the first to systematically summarize all relevant studies reporting on sleep, cognition, and behavioral problems in healthy school-age children (5-12 years old) and incorporates 86 studies on 35,936 children. Sleep duration shows a significant positive relation with cognitive performance (r = .08, confidence interval [CI] [.06, .10]). Subsequent analyses on cognitive subdomains indicate specific associations of sleep duration with executive functioning (r = .07, CI [.02, .13]), with performance on tasks that address multiple cognitive domains (r = .10, CI = [.05, .16]), and with school performance (r = .09, CI [.06, .12]), but not with intelligence. Quite unlike typical findings in adults, sleep duration was not associated with sustained attention and memory. Methodological issues and brain developmental immaturities are proposed to underlie the marked differences. Shorter sleep duration is associated with more behavioral problems (r = .09, CI [.07, .11]). Subsequent analyses on subdomains of behavioral problems showed that the relation holds for both internalizing (r = .09, CI [.06, .12]) and externalizing behavioral problems (r = .08, CI [.06, .11]). Ancillary moderator analyses identified practices recommended to increase sensitivity of assessments and designs in future studies. In practical terms, the findings suggest that insufficient sleep in children is associated with deficits in higher-order and complex cognitive functions and an increase in behavioral problems. This is particularly relevant given society's tendency towards sleep curtailment.
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“Nocturnal sleep disturbances affect daytime functioning, which is crucial for students’ performance during waking hours, and sleep plays a key role in cognitive function [79].”
From A serial mediation model of social media addiction and college students' academic engagement: the role of sleep quality and fatigue (2023) · cites this paper as [79]
In the citing paper
“Several studies indicated that sleep disturbances and sleep loss impairs learning and school performance in children (for reviews, see Refs.44,246,286,662,1178).”
From About Sleep's Role in Memory (2013) · cites this paper as [44]
In the citing paper
“Of note, a recent systematic review and meta-analysis concluded that insufficient sleep was associated with deficits in higher-order and complex cognitive functions and an increase in behavioral problems in children. 44”
From Physical Activity for Cognitive and Mental Health in Youth: A Systematic Review of Mechanisms (2016) · cites this paper as [44]
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Schlaf und Kognition bei Kindern und Jugendlichen
Prehn‐Kristensen, A., & Göder, R. (2018) · Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie · doi:10.1024/1422-4917/a000614 · Cited by 11
Morrison, A. C., Hall, T. A., Kumar, V., & Williams, C. N. (2023) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2023.01.002 · Cited by 9
Chen, Y., Zhang, L., Zhang, J., Hong, Y., Zhou, Y., Li, Q., & Li, X. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.08.095 · Cited by 9
Metacognitive function in young adults is impacted by physical activity, diet, and sleep patterns
Gooderham, G. K., & Handy, T. C. (2025) · PLoS ONE · doi:10.1371/journal.pone.0317253 · Cited by 10
Werner, A., Hachenberger, J., Spiegelhalder, K., Rueth, J., Schlarb, A. A., Lohaus, A., & Lemola, S. (2025) · Journal of Sleep Research · doi:10.1111/jsr.14467 · Cited by 10
“Furthermore, TST and SE are commonly analysed actigraphic sleep measures, which have also been consistently defined and operationalized in previous studies (Astill et al., 2012; Konjarski et al., 2018).”
Hamada, T., Seki, M., Nango, E., Shibata, T., Imai, S., & Miyata, T. (2025) · Psychiatry Research · doi:10.1016/j.psychres.2025.116447 · Cited by 10
“Children with ADHD often experience sleep problems (Sung et al., 2008), and poor sleep is linked to inattention (Waldon et al., 2018) as well as cognitive and behavioral issues (Astill et al., 2012).”
Al‐Sabah, R., Al‐Taiar, A., Rahman, A., Shaban, L. H., Al-Harbi, A., & Mojiminiyi, O. A. (2020) · Scientific Reports · doi:10.1038/s41598-020-63089-2 · Cited by 11
Association of Lifestyle Factors and Neuropsychological Development of 4-Year-Old Children
O’Connor, G., Júlvez, J., Fernández‐Barrés, S., Navarrete‐Muñoz, E. M., Murcia, M., Tardón, A., Galán, I. R., Amiano, P., Ibarluzea, J. M., García‐Esteban, R., et al. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17165668 · Cited by 9
“A lack of sleep has been found to be detrimental to certain neurocognitive functions and is associated with more behavioral problems [4].”
BackgroundŞahin, B., Hoşoğlu, E., & Önal, B. S. (2021) · Sleep Medicine · doi:10.1016/j.sleep.2021.04.002 · Cited by 9
Bakth, F. N., Chen, M., & Wang, Y. (2023) · Sleep Health · doi:10.1016/j.sleh.2023.01.006 · Cited by 9
Wetter, S. E., Fuhs, M. W., & Goodnight, J. A. (2019) · Early Child Development and Care · doi:10.1080/03004430.2019.1573226 · Cited by 9
“Poor or inadequate sleep can impair social, emotional, and cognitive functioning in children due to its effects on the developing brain (Astill et al., 2012; Philbrook et al., 2017; Huntley & Lewin, 2006; Sadeh et al., 2003; Steenari et al., 2003).”
BackgroundThe relationship between cognitive ability and BOLD activation across sleep–wake states
Fang, Z., Smith, D., Houldin, E., Ray, L. B., Owen, A. M., & Fogel, S. M. (2021) · Brain Imaging and Behavior · doi:10.1007/s11682-021-00504-w · Cited by 9
Using Parental Report to Identify Children at Risk for Poor Sleep and Daytime Problems
Gruber, R., Somerville, G., & Santisteban, J. A. (2020) · Behavioural Sleep Medicine · doi:10.1080/15402002.2019.1613236 · Cited by 10
Griffith, S. F., & Qiu, Y. (2022) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000001115 · Cited by 8
“It is also possible that variables, including sleep and shared reading, might be mediators of certain effects, particularly given their close relations to early learning and behavior.(26,28) Further longitudinal research would be needed to evaluate mediation or moderated mediation effects.”
BackgroundBarnard-Kelly, K. D., Marrero, D. G., de Wit, M., Pouwer, F., Khunti, K., Hermanns, N., Pierce, J. S., Laffel, L. M., Holt, R. I. G., Battelino, T., et al. (2024) · Diabetic Medicine · doi:10.1111/dme.15484 · Cited by 8
“In the sub-category of treatment satisfaction, there are tools to assess generalized diabetes treatment/technology satisfaction (76; 77), utility of glucose monitoring technologies (78), insulin delivery systems (79, 80), automated insulin delivery systems (81), as well as usability of technologies…”
Thompson, M. J., Ehrhardt, A. D., Saini, E. K., Yip, T., Buckhalt, J., & El-Sheikh, M. (2025) · Sleep · doi:10.1093/sleep/zsaf166 · Cited by 7
“Prior meta-analyses have found significant but modest links between sleep, particularly sleep duration, and multiple cognitive domains [2, 3, 6].”
Going to sleep and going to school: Linking bedtime to student absenteeism
Gottfried, M. A., & Kirksey, J. J. (2021) · Journal of Sleep Research · doi:10.1111/jsr.13396 · Cited by 7
Morales‐Muñoz, I., Nolvi, S., Mäkelä, T. E., Eskola, E., Korja, R., Fernandes, M., Karlsson, H., Paavonen, E. J., & Karlsson, L. (2021) · Sleep Science and Practice · doi:10.1186/s41606-021-00064-4 · Cited by 9
Difficult to Bed and Difficult to Rise: Complex Interplay Among ADHD, Sleep, and Adolescence
Becker, S. P., & Langberg, J. M. (2017) · The ADHD Report · doi:10.1521/adhd.2017.25.1.7 · Cited by 8
Assessment and initial management of suspected behavioural insomnia in pre-adolescent children
Hill, C. M., & Everitt, H. (2018) · BMJ · doi:10.1136/bmj.k3797 · Cited by 8
Childhood Sleep Functioning as a Developmental Precursor of Adolescent Adjustment Problems
Jiskrova, G. K., Vazsonyi, A. T., Klánová, J., & Dušek, L. (2019) · Child Psychiatry & Human Development · doi:10.1007/s10578-019-00926-0 · Cited by 8
Well-Slept Children and Teens are Happier and More Hopeful with Fewer Emotional Problems
Lau, E. Y. Y., Lam, Y. C., & Lee, J. C. (2021) · Child Indicators Research · doi:10.1007/s12187-021-09823-2 · Cited by 9
Parental Overprotection and Sleep Problems in Young Children
Pizzo, A., Sandstrom, A., Drobinin, V., Propper, L., Uher, R., & Pavlová, B. (2021) · Child Psychiatry & Human Development · doi:10.1007/s10578-021-01199-2 · Cited by 8
Sleep and behavioral problems in preschool-age children with Down syndrome
Fucà, E., Costanzo, F., Ursumando, L., Celestini, L., Scoppola, V., Mancini, S., Valentini, D., Villani, A., & Vicari, S. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.943516 · Cited by 8
“Given the documented longitudinal effects of sleep disturbance on behavioral problems in children (Gregory et al., 2009; Quach et al., 2009; Astill et al., 2012; El-Sheikh et al., 2013; Armstrong et al., 2014), including children with DS (Horne et al.”
BackgroundMansolf, M. A., Blackwell, C. K., Chandran, A., Colicino, E., Geiger, S. D., Harold, G. T., McEvoy, C. T., Junior, H. P. D. O. S., Sherlock, P., Bose, S., et al. (2023) · Journal of Child and Family Studies · doi:10.1007/s10826-023-02624-x · Cited by 8
“Given the negative consequences of poor sleep on brain development and cognitive processing (Astill et al., 2012; Beebe, 2011), social-emotional adjustment (Gregory & Sadeh, 2012), physical health (Shochat et al., 2014), and overall quality of life (Strine & Chapman 2005), sleep health has become a…”
BackgroundLopes, S., Almeida, F. T., Jacob, S., Figueiredo, M., Vieira, C., & Carvalho, F. (2017) · Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) · doi:10.25753/birth&growthmj.v25.i4.10798 · Cited by 8
Parental relationship dissolution and child development: the role of child sleep quality
Rudd, B. N., Holtzworth‐Munroe, A., D'Onofrio, B. M., & Waldron, M. (2018) · SLEEP · doi:10.1093/sleep/zsy224 · Cited by 8
Brand, S., Schilling, R., Ludyga, S., Colledge, F., Bahmani, D. S., Holsboer‐Trachsler, E., Pühse, U., & Gerber, M. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00754 · Cited by 8
Fear of hypoglycemia and sleep in children with type 1 diabetes and their parents
Schierloh, U., Aguayo, G. A., Fichelle, M., De Melo Dias, C., Schritz, A., Vaillant, M., Barnard-Kelly, K., Cohen, O., Gies, I., & de Beaufort, C. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1419502 · Cited by 7
“In parents, the adjusted mean score was 40.67 (95% CI [33.1; 48.3]) in treatment A and decreased by -2.9 (95% CI [-7.0; 1.3]) points for device B.”
Influential
Metadata
- Authors
- Astill, R. G., Van der Heijden, K. B., Van IJzendoorn, M. H., & Van Someren, E. J. W.
- Affiliations
- Netherlands Institute for Neuroscience (NL)
- Venue
- Psychological Bulletin
- Published
- 2012
- Volume
- 138
- Issue
- 6
- Pages
- 1109-1138
- ISSN
- 0033-2909 (ISSN-L)
- 1939-1455
- OpenAlex
- W2151099567
- Cited by
- 707
- References
- 226
- Citations by year
- 2026: 54 · 2025: 55 · 2024: 65 · 2023: 59 · 2022: 62 · 2021: 70 · 2020: 65 · 2019: 51 · 2018: 43 · 2017: 44 · 2016: 39 · 2015: 37 · 2014: 30 · 2013: 24 · 2012: 5
- FWCI
- 41.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Bulletin (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- KNAW research portal (Royal Academy of Art and Sciences (KNAW)) (publishedVersion)
- VU Research Portal (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- Funders
- Netherlands Organization of Scientific Research
- The Hague (VICI Innovation Grant 453-07-001)
- National Initiative Brain & Cognition Research Program (“Innovative Learning Materials and Methods” Grant 056-32-013)
- Sponsor name not included
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- sleep duration, elementary school students, cognitive performance, behavioral problems, executive function, academic performance, internalizing problems, externalizing problems, sustained attention, memory, sleep deprivation, brain development, intelligence
- MeSH terms
- Achievement, Child, Child Behavior Disorders, Child, Preschool, Cognition, Female, Humans, Male, Sleep, Sleep Wake Disorders, Time Factors
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