well as factors that interfere with healthy decisions, such as poverty, neighborhood stresses, family tensions, and a general lack of child supervision.

While there is a commonsense element to interventions aimed at improving modifiable lifestyle factors, future efforts must rigorously document the promotion and prevention outcomes of their adoption. Promotion of mental health early in young people’s lives using such universal strategies that are feasible, inexpensive, and scientifically compelling holds great promise.


Sleep deprivation and sleep-related breathing disorder (SBD) are linked to emotional and behavioral problems that include hyperactivity, inattention, impulsivity, mood lability, and aggression (Institute of Medicine, 2006c; Rosen, Storfer-Isser, et al., 2004; Wolraich, Drotar, et al., 2008). Hyperactivity and attention disorders are associated with two other sleep disorders—restless leg syndrome and periodic limb movement disorders (Chervin, Hedger Archbold, et al., 2002).

Given that 20 percent or more of children have sleep problems, the contribution of SBD and other sleep problems to behavioral disorders is potentially enormous, though largely underrecognized. Interventions to improve sleep duration and quality must be rigorously assessed to determine their potential for improving emotional and behavioral outcomes. For example, a program to screen all children in primary care based on a history of snoring, interrupted sleep, and insufficient hours of sleep could be followed by a behavioral assessment using validated instruments and behavioral interventions as indicated. Studies are needed to demonstrate that the treatment of obstructive sleep apnea with tonsillectomy and adenoidectomy or other measures reduces the occurrence of behavioral consequences. A more general proposed approach to healthy sleep is the establishment of a multimedia public education campaign targeting specific populations, such as children, their parents, teachers in preschool and elementary school, college students, and young adults (Institute of Medicine, 2006c). The intent of such a campaign would be awareness concerning the consequences of insufficient or disrupted sleep, leading to identification of these problems and reestablishment of healthy sleeping patterns.

Diet and Nutrition

Adverse emotional and behavioral outcomes for children have long been linked to dietary factors. However, many suggested nutritional interventions have little or no evidence base. Prenatal nutrition was addressed in Chapter 6. Postnatal nutrition factors include hunger, undernutrition, and failure to thrive, which have been linked to cognitive and behavioral

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