(PS6-25) Sleep Deficiencies and Proactive versus Reactive Aggression Among Peripubertal Youth Receiving Intensive Psychiatric Services

Background: Sleep deficiencies (e.g., insufficient duration, low quality) are common in childhood and adolescence and are linked with increased aggressive behavior. Research has shown that sleep deficiencies are more strongly related to reactive than proactive aggression. However, limited research has been conducted in peripubertal youth (9-12) with severe psychopathology nor integrated objective and subjective assessments of sleep. The purpose of the current study was to conduct a preliminary analysis exploring the association between objective and subjective sleep deficiencies and peripubertal youth proactive and reactive aggression in a sample of youth receiving treatment in a partial psychiatric hospitalization setting.

Method: A subsample of 14 peripubertal youth (ages 9-12) admitted to a mental health partial hospitalization program who participated in a sleep research study were included in the current study. The participants were 58% Non-Hispanic White, 17% Black, 17% Latino, and 8% Asian. Thirty-six percent identified as female, 29% as male, and 35% as non-binary. Youth completed two weeks of sleep assessment using multi-informant baseline questionnaires and daily diaries, as well as wearing a Fitbit Charge 5 to assess objective total sleep time based on activity and heart rate. The Proactive/Reactive Aggression scale for child-report was used to assess aggression. The pediatric self-report and parent proxy version of the PROMIS Sleep Disturbances subscale was used to assess subjective sleep deficiencies. Fitbit-derived total sleep time across two weeks was used for an objective assessment.

Results:  Proactive and reactive aggression were positively correlated (r = .49). Higher objective total sleep time was correlated with lower reactive (r = -.20) but not proactive (r = .07) aggression. Parent and youth-reported sleep duration was largely uncorrelated with reactive or proactive aggression. Higher youth-reported sleep disturbances were related to higher levels of reactive (r = .34) but not proactive (r = .10) aggression. Conversely, higher parent-reported youth sleep disturbances were related to higher proactive (r = .51) but no reactive (r = .02) aggression.

Discussions: Findings show associations between sleep deficiencies and peripubertal proactive and reactive aggression. However, the strength and pattern of these associations depend on the informant and method. Results support the use of multi-informant and multi-method approaches to sleep assessment. Additional results from this ongoing study will examine rates of change across intensive treatment and may inform clinical practice guidelines for youth in partial psychiatric hospital settings.