Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep MedicineOct 4, 2021

Links between body clock patterns, insomnia, and emotional and behavior problems in school-age children

Circadian Biology Weekly Brief ↗PubMed ↗DOI ↗

Updated Mar 31, 2026

Abstract

Evening chronotype is significantly associated with insomnia symptoms and behavioral problems in school-age children.

Children with an evening chronotype experience greater bedtime resistance and delays in sleep onset.
Social jetlag does not appear to be linked to insomnia symptoms in this population.
Evening chronotype is associated with increased externalizing behavioral symptoms.
These findings highlight the potential impact of circadian factors on sleep and mental health in children.

Simplified

STUDY OBJECTIVES: To examine the associations of circadian characteristics (ie, chronotype and social jetlag) with insomnia symptoms and emotional and behavioral problems among school-age children.

METHODS: A total of 620 primary school children (median= 10.06, standard deviation = 1.16, 58.7% boys) were recruited and assessed by a set of parent-report questionnaires, including Children's Sleep Habit Questionnaire for measuring sleep-wake patterns and insomnia symptoms (bedtime resistance, sleep onset delay, and night waking), Children's Chronotype Questionnaire for assessing the child's chronotype preference, and Strength and Difficulties Questionnaire for assessing emotional and behavioral problems. Linear regression models were applied to examine the associations of chronotype and social jetlag with insomnia symptoms and mental health outcomes, in which age, sex, family income, and average sleep duration were entered as covariates. age

RESULTS: Evening chronotype was significantly associated with bedtime resistance and sleep onset delay, while social jetlag was not related to insomnia symptoms. Evening chronotype was also significantly associated with externalizing symptoms after controlling for potential confounders.

CONCLUSIONS: Evening chronotype, but not social jetlag, was the risk factor for insomnia symptoms, and evening chronotype was further associated with increased behavioral problems in school-age children. Our findings underscored the roles of circadian factors in relation to sleep and mental health problems in this young population.

CITATION: Sun W, Kwok NTT, Chan NY, et al. Associations of circadian factors with insomnia symptoms and emotional and behavioral problems among school-age children.. 2021;17(10):2107-2114. J Clin Sleep Med

Funding

Competing interests

All the authors have read and approved the manuscript. Work for this study was performed in the Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong. The study was supported by the Seed Fund for Basic Research, University Research Committee, The University of Hong Kong. The funding body had no involvement in the study design and the collection, analysis, and interpretation of the data, the writing of the report, or the decision to submit the paper for publication. The funding was awarded to Dr. Shirley Xin Li. The authors report no conflicts of interest.

PubMed

Links between body clock patterns, insomnia, and emotional and behavior problems in school-age children

Abstract

Funding

Competing interests

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Abstract

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