Henderson, L. M., & Sullivan, E. C. (2025) Child and Adolescent Mental Health.
Smartphones – used for accessing social media, gaming and peer interaction – account for the majority of screen time among children and adolescents, with many exceeding 5 h of daily use. Despite growing concern over negative impacts, action to safeguard our children from the potentially damaging effects has been slow, with concern dismissed as ‘moral panic’ in the absence of definitive causal evidence. Obtaining causal evidence is fraught with methodological challenges, exemplified by Lai and colleagues' timely synthesis of school-based interventions to reduce screen time. Such approaches (e.g. self-guided strategies/educational interventions) provide limited evidence of behaviour change and, unsurprisingly, effects rarely transfer to critical outcomes such as well-being and academic performance. Alongside gathering robust theory-driven causal evidence that can lead to strategies for promoting healthy digital behaviours, these findings reinforce the need to draw on multiple strands of evidence to inform policy. A multi-sector approach – spanning education, health and home – co-designed with young people is essential to fostering a healthier digital future.
Emotional inertia is independently associated with cognitive emotion regulation strategies and sleep quality.
Sullivan, E. C., McCall, C., Brose, A., Henderson, L. M., & Cairney, S. A. (2024) Cognition and Emotion.
Emotional inertia (i.e. the tendency for emotions to persist over time) is robustly associated with lower wellbeing. Yet, we know little about the mechanisms underlying this relationship. Good quality sleep and frequent use of adaptive cognitive emotion regulation (CER) strategies reduce the persistence of negative affect (NA) over time. However, whether sleep and adaptive CER strategy use work in concert to reduce NA inertia is unclear. In the current study, participants (N = 245) watched a series of film clips and rated how each clip made them feel on negative and positive affective states. Emotion ratings were collected again after a short rest period to determine the persistence of clip-induced affect. Standardised questionnaires were used to index participants’ sleep quality and tendency to engage in adaptive CER strategies. Autoregressive models demonstrated that better sleep quality was associated with lower NA inertia (d = 0.25). This association also held when controlling for mean and variability of NA. Interestingly, the association between adaptive CER strategy use and NA inertia was observed irrespective of whether sleep quality was good, average, or poor (d = 0.13). These findings suggest that sleep and adaptive CER strategies hold independent rather than interdependent roles in maintaining emotional wellbeing.
The Influence of Emotion Regulation Strategies and Sleep Quality on Depression and Anxiety.
Sullivan, E. C., James, E., Henderson, L. M., McCall, C., & Cairney, S. A. (2023). Cortex.
Chronic stress is a major risk factor for a number of mental health disorders, including depression and pathological anxiety. Adaptive cognitive emotion regulation (CER) strategies (i.e. positively-focused thought processes) can help to prevent psychiatric disturbance when enduring unpleasant and stressful experiences, but little is known about the inter-individual factors that govern their success. Sleep plays an important role in mental health, and may moderate the effectiveness of adaptive CER strategies by maintaining the executive functions on which they rely. In this study, we carried out a secondary analysis of self-reported mental health and sleep data acquired during a protracted and naturally-occurring stressor – the COVID-19 pandemic – to firstly test the hypothesis that adaptive CER strategy use is associated with positive mental health outcomes and secondly, that the benefits of adaptive CER strategy use for mental health are contingent on high-quality sleep. Using established self-report tools, participants estimated their depression (N = 551) and anxiety (N = 590) levels, sleep quality and tendency to engage in adaptive and maladaptive CER strategies during the Spring and Autumn of 2020. Using a linear mixed modelling approach, we found that greater use of adaptive CER strategies and higher sleep quality were independently associated with lower self-reported depression and anxiety. However, adaptive CER strategy use was not a significant predictor of self-reported anxiety when accounting for sleep quality in our final model. The positive influence of adaptive CER strategy use on depression was observed at different levels of sleep quality. These findings highlight the importance of adaptive CER strategy use and good sleep quality in promoting resilience to depression and anxiety when experiencing chronic stress.
Anxiety, Insomnia and Napping Predict Poorer Sleep Quality in an Autistic Adult Population.
Sullivan E., Halstead, E. J., Ellis, J. G., & Dimitriou, D. (2021). International Journal of Environmental Research and Public Health.
Autistic adults have a high prevalence of sleep problems and psychiatric conditions. In the general population sleep problems have been associated with a range of demographic and lifestyle factors. Whether the same factors contribute to different types of disturbed sleep experienced by autistic adults is unknown and served as the main aim of this study. An online survey was conducted with 493 autistic adults. Demographic information (e.g., age, gender), about lifestyle (e.g., napping), and information about comorbid conditions was collected. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality and the Epworth Sleepiness Scale (ESS) was used to assess daytime somnolence. Stepwise multiple regression analyses were used to examine predictors of each subscale score on the PSQI, as well as PSQI and ESS total scores. Results indicated that individuals who reported having a diagnosis of anxiety and insomnia were more likely to have poorer sleep quality outcomes overall. Furthermore, individuals who reported habitually napping had higher daytime dysfunction, increased sleep disturbances, and increased daytime sleepiness. These results provide novel insights into the demographic and lifestyle factors that influence sleep quality and daytime somnolence in autistic adults and can be used for targeted sleep interventions.
The Impact of COVID-19 on Sleep in Autistic Adults: Longitudinal Comparisons pre and During Lockdown.
Halstead, E. J., Sullivan E., & Dimitriou, D. (2021). Frontiers in Psychiatry.
Background: The longer-term impact of the pandemic on autistic adults' sleep are yet to be revealed, with studies concentrating on sleep in autistic children or mental health outcomes and coping strategies of autistic adults. Given the prevalence of sleep problems experienced by autistic adults and the changes in routine that have occurred as a result of COVID-19 societal restrictions, this study assessed the impact of the COVID-19 pandemic on sleep problems via a longitudinal subjective assessment method.
Methods: Sleep data were gathered at three time points from 95 autistic adults, namely prior to the pandemic, at the start of COVID-19 and several months into COVID-19 to obtain a rich longitudinal dataset ascertaining how/if sleep patterns have changed in autistic adults over these several months.
Results: In comparison to pre-lockdown, several sleep components were shown to improve during the lockdown. These improvements included reduced sleep latency (time taken to fall asleep), longer sleep duration, improved sleep efficiency, improved sleep quality, as well as improved daytime functioning. Pre-sleep cognitive arousal scores were found to decrease compared to pre-lockdown, meaning cognitive arousal improved. Approximately 65% of participants reported that they felt their sleep had been impacted since COVID-19 since Time 1, with the most common reasons reported as waking up exhausted (36.92%), not being able to get to sleep (33.85%), waking up in the night (29.23%), having a disrupted sleep pattern (27.69%), and nightmares (18.46%).
Conclusions: Improvements in sleep may be related to societal changes (e.g., working from home) during the pandemic. Some of these changes are arguably beneficial for autistic adults in creating a more autism-inclusive society, for example telehealth opportunities for care. Further exploration of the associations between mental health and sleep are warranted.
The Treatment of Sleep Problems in Autistic Adults in the United Kingdom.
Halstead, E. J., Sullivan E., Zambelli, Z., Ellis, J. G., & Dimitriou, D. (2021). Autism.
Sleep problems are one of the most common complaints in autistic adults. This study aimed to report the perspectives of autistic adults in the United Kingdom on treatment of their sleep problems. A total of 288 autistic adults living in the United Kingdom completed an online survey including assessments of their sleep quality using the Pittsburgh Sleep Quality Index, reporting their experiences and preferences of sleep treatment with UK healthcare professionals and, their experiences of self-management of their sleep. Self-report data revealed 58% of participants had not attended a consultation with a healthcare professional regarding their sleep problem despite 90% meeting the criteria for poor sleep quality (based on the Pittsburgh Sleep Quality Index). Of the participants who attended a consultation for their sleep, 72% were prescribed medication and 60% were not satisfied with the outcome. Self-management of sleep problems was not effective for 80% of participants; 41% reported a preference for non-medication options such as education, advice and talking therapies for sleep treatment. This report highlights the need for a fundamental shift in the consideration of sleep problems in autistic adults given the high levels of co-morbidity. The development of successful management strategies in adulthood that importantly considering autistic adults’ preferences could reduce sleep problems and overall improve quality of life for autistic adults. Long term this could also reduce the need for prescribed medication in this population.
Sleep disturbances and patterns in children with neurodevelopmental conditions.
Halstead, E. J., Joyce, A., Sullivan, E., Tywyn, C., Davies, K., Jones, A., & Dimitriou, D. (2021). Frontiers in Paediatrics.
Background: Children with neurodevelopmental conditions (NDC) often experience sleep problems which are long-lasting and more complex than typically developing children. These sleep problems impact their families and there is little guidance for management specifically for sleep for families of children with neurodevelopmental conditions. The present study aims to use parental report to evaluate sleep disturbances and sleep patterns in a large sample of children with NDC. We aim to identify associations with age, diagnosis, and medication groups.
Methods: Data on 601 children aged between 2 and 17 years was analyzed from a UK non-profit service for sleep for families of children with NDC. Parents/carers completed the children's sleep habit questionnaire, a 7 day sleep diary, and information on child age, diagnosis, and medication. Parents also reported previous sleep management techniques they had tried.
Results: Overall, we found differences between age, diagnosis, and medication use groups for sleep disturbances and sleep diary parameters in these populations. Sensory conditions were associated with high night time waking duration. Parents reported their child's short sleep duration was the most common problem for them.
Conclusions: Key areas for further research are outlined including the long term considerations for parental presence at bedtime for sleep anxiety, melatonin use and efficacy, and consideration for interventions to reduce daytime fatigue in children aged 7–11 years old.
The role of executive functions in socioeconomic attainment gaps: Results from a randomized controlled trial.
Blakey, E., Matthews, D., Cragg, L., Buck, J., Cameron, D., Higgins, B., Pepper, L., Ridley, E., Sullivan, E., & Carroll, D. J. (2020). Child development.
The socioeconomic attainment gap in mathematics starts early and increases over time. This study aimed to examine why this gap exists. Four-year-olds from diverse backgrounds were randomly allocated to a brief intervention designed to improve executive functions (N = 87) or to an active control group (N = 88). The study was preregistered and followed CONSORT guidelines. Executive functions and mathematical skills were measured at baseline, 1 week, 3 months, 6 months, and 1 year posttraining. Executive functions mediated the relation between socioeconomic status and mathematical skills. Children improved over training, but this did not transfer to untrained executive functions or mathematics. Executive functions may explain socioeconomic attainment gaps, but cognitive training directly targeting executive functions is not an effective way to narrow this gap.