Sleep disturbance as a transdiagnostic marker of children's mental health difficulties: A network analysis of item-level associations between different types of sleep problems and different behavioural and emotional symptoms.

Background: Sleep disturbances are widely considered to be a transdiagnostic feature of common behavioural and emotional difficulties in childhood, yet most studies treat sleep as a single construct. Where studies have explored specific sleep problems to psychopathology in children, these tend to only include behavioural or emotional difficulties, ignoring the often-observed covariance between them. These study limitations kerb our knowledge over whether individual sleep disturbances are universal (transdiagnostic) or specific to individual symptom types. Objectives: To address these gaps, we aimed to map item-level associations between specific sleep problems and behavioural and emotional symptoms using a network approach. We predicted that nodes would organise into clusters corresponding to behavioural symptoms, emotional symptoms, and various sub-types sleep problems. We also expected sleep problems to be central in the network. Methods: We used data from the Development of Emotional Resilience cohort, which comprises a sample of children living in East London ( Results: Seven symptom clusters emerged, reflecting distinct clusters of behavioural symptoms, some mixed sleep-emotional symptoms, and mixed sleep problems. Node centrality analyses identified anxiety and sleep anxiety items as the most central nodes in the network. Among the top bridge nodes linking clusters in the network were problems with appetite, trouble sleeping, daytime sleepiness, and anticipatory worry about bedtime, potentially reflecting transdiagnostic pathways across symptom domains. Conclusion: Sleep and bedtime-related anxiety may act as central, transdiagnostic mechanisms, proximally in relation to emotional symptoms and distally in relation to behavioural symptoms. Targeted interventions focussing on sleep anxiety may benefit children across symptom domains.