Structural Relationships Between Behavioral Problems, Sensory Processing Traits, and Sleep Among Preschoolers

IMPORTANCE: An association between sensory processing difficulties and behavioral problems among children has been reported in previous studies. Sleep problems among children can lead to both externalizing and internalizing behavioral problems. However, the relationships between sensory processing and sleep among children are not well understood. OBJECTIVE: To develop a structural causal model (SCM) predicated on the hypothesis that sensory processing difficulties and sleep problems are closely related among preschoolers and may contribute to behavioral issues. DESIGN: Cross-sectional study. PARTICIPANTS: A total of 168 children ages 3-5 yr who were enrolled in a preschool or an accredited kindergarten (four facilities in total) in a Japanese prefecture participated in the analysis. OUTCOMES AND MEASURES: After gaining the cooperation of educators, we distributed the following items to the children's parents: an informed consent form, the Short Sensory Profile-Japanese version (SSP-J), the Japanese Sleep Questionnaire for Preschoolers (JSQ-P), and the Child Behavior Checklist for Ages 1.5-5. Through factor analysis of the SSP-J and the JSQ-P, we identified common factors. We developed an SCM using structural equation modeling. RESULTS: Four factors were identified by factor analysis: attention deficit, sensory sensitivity, sleep problems, and restless legs syndrome symptoms. The final structural equation modeling analysis had an acceptable goodness of fit (goodness-of-fit index = .862; root-mean-square error of approximation = .087). CONCLUSIONS AND RELEVANCE: The model suggests that sensory sensitivity and sleep difficulties may contribute to behavioral issues among preschoolers. Plain-Language Summary: The results of this study suggest that relationships exist between behavioral problems, sensory processing, and sleep among preschoolers. The authors developed a model that identified four common factors that contribute to behavioral issues among preschoolers: attention deficit, sensory sensitivity, sleep problems, and restless legs syndrome symptoms. Children's behavioral problems are an important consideration for occupational therapy practitioners working with preschoolers. Sensory processing and sleep must be accurately evaluated to address preschoolers' behavioral issues.