ISSN 2317-1782 (Online version)

Correlation between sleep profile and

Original Article
Artigo Original behavior in individuals with specific learning
disorder
Amanda Maião Franklin1
Célia Maria Giacheti1
Nathani Cristina da Silva1 Correlação entre o perfil do sono e o
Leila Maria Guissoni Campos2
Luciana Pinato1
comportamento em indivíduos com transtorno
específico da aprendizagem

Keywords ABSTRACT
Neurodevelopment Purpose: This study aimed to correlate sleep profile and behavior in individuals with Specific Learning Disorder
Behavior (SLD). Methods: The Sleep General Habits Questionnaire, Sleep Diary, and Sleep Disturbance Scale for Children
(SDSC) were used in analysis of sleep, whereas the Child Behavior Checklist (CBCL) inventory was used in
Sleep analysis of behavior. Results: 65.5% of the individuals with SLD presented symptoms of sleep disorders, most
CBCL frequently wakefulness-sleep transition and sleep disturbance total score, which showed values higher than
Learning acceptable. In addition, individuals with SLD presented higher sleep latency than those with typical development.
Concerning behavior, 72.4% of the individuals with SLD presented clinical condition of behavior problems.
In the control group, none of the participants showed symptoms of sleep or behavior problems. In the SLD group,
correlation was observed between behavioral problems and sleep disturbance. Conclusion: Individuals with
SLD showed high rates of sleep disturbance and behavioral problems. The worse the sleep disturbance, the
worse the behavioral aspects in these individuals.

Descritores RESUMO
Neurodesenvolvimento Objetivo: Correlacionar o sono e o comportamento em indivíduos com transtorno específico da aprendizagem.
Comportamento Método: Na análise do sono, foram utilizados o Questionário de Hábitos Gerais de Sono, o Diário de Sono e
a Escala de Distúrbios do Sono em Crianças (EDSC) e, para análise do comportamento, foi utilizado o Child
Sono Behavior Checklist (CBCL). Resultados: 65,5% dos indivíduos com transtorno específico de aprendizagem
CBCL apresentaram indicativo de distúrbios de sono, sendo os mais frequentes os distúrbios de transição sono-vigília e
Aprendizagem escores totais para distúrbios de sono acima do aceitável. Além disso, os indivíduos com transtorno específico de
aprendizagem apresentaram maior latência de sono que o respectivo grupo controle. Quanto ao comportamento,
72,4% dos indivíduos com transtorno específico de aprendizagem apresentaram quadro clínico de problemas
comportamentais. No grupo controle, nenhum dos participantes apresentou indicativo de problemas de sono ou
comportamento. No grupo transtorno específico de aprendizagem, os distúrbios de sono encontrados apresentaram
correlação com os problemas comportamentais. Conclusão: Indivíduos com transtorno específico da aprendizagem
apresentaram altos índices de distúrbios de sono e alterações comportamentais. Quanto piores os distúrbios de
sono, piores foram os aspectos comportamentais dos indivíduos com transtorno específico da aprendizagem.

Correspondence address Study conducted at Universidade Estadual Paulista – UNESP - Marília (SP), Brasil.
Luciana Pinato 1
Faculdade de Filosofia e Ciências, Universidade Estadual Paulista – UNESP - Marília (SP), Brasil.
Av. Hygino Muzzi Filho, 737, Mirante, 2
Universidade de Marilia – UNIMAR - Marília (SP), Brasil.
Marília (SP), Brasil, CEP: 17525-000.
Financial support: Programa Institucional de Bolsas de Iniciação Científica, CNPq proc. 26212/2013.
E-mail: lpinato@marilia.unesp.br
Conflict of interests: nothing to declare.
Received: May 16, 2017

Accepted: December 04, 2017 This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Franklin et al. CoDAS 2018;30(3):e20170104 DOI: 10.1590/2317-1782/20182017104 1/8

INTRODUCTION that improvement in the quality of sleep enhances academic
achievement(15,16).
Language is a complex higher cortical function that Considering the high prevalence of sleep disorders in
includes understanding, production, and use of different children with poor school performance(17), it is important to
modes of communication (e.g., gestural, speaking and writing investigate whether sleep pattern is associated with the behavior
elements) determined by biological, psychic, regional, social and of individuals with SLD, because this may be a factor that justifies
cultural/ethnic factors, and requires intact anatomo-functional or worsens the condition, which influences performance during
basis associated with external stimuli to provide adequate pre- or regular school, or yet the success of Speech-language
development(1,2). Pathology intervention.
Among the various neurodevelopmental disorders cared in The objective of the present study was to correlate sleep
Speech-language Pathology practice, specific learning disorder profile and behavior in individuals with SLD with its respective
(SLD), which includes the persistent disorders of reading, writing control group.
and mathematics, should be highlighted(3).
This diagnostic condition can affect school-age children and METHODS
adolescents who necessarily present persistent failure in learning
and using academic skills (reading, writing and/or mathematics), Study sample
and is indicated by presence of the symptoms described in the
Study participants were 58 individuals of both genders aged
Fifth Edition of the Diagnostic and Statistical Manual of Mental
8-13 years divided into two groups: Specific Learning Disorder
Disorders (DSM-5)(3), namely: (1) impairment in word reading
(SLD), composed of 29 individuals assessed in five 50-min
accuracy, reading rate or fluency (2) impairment in reading
sessions in a Speech-language Pathology school clinic (Centro
comprehension; (3) impairment in spelling accuracy, grammar
Especializado em Reabilitação - CER - UNESP - Marília - SP)
and punctuation accuracy, clarity or organization of written
to define the diagnosis of SLD (Table 1), and its Control Group
expression (4) impairment in mathematics with (5) number sense,
(Control), composed of 29 individuals with typical learning
memorization of arithmetic facts, accurate or fluent calculation
development (reading, writing, and mathematics) matched for
and (6) accurate math reasoning. These disabilities must
sex and age to those in the study group (Table 1).
necessarily persist longer than six months, even with interventions
Individuals in both groups were attending a public school in
developed by the school, pedagogues/psycho-pedagogues, or
the municipality where the research was conducted, enrolled in
speech-language pathologists.
Elementary and Middle School. The study was approved by the
SLD is characterized by persistent deleterious impairment
Research Ethics Committee of the aforementioned Institution
in basic academic reading (e.g., reading accuracy or fluency
under protocol no. 0698/2013. All parents and/or legal guardians
and comprehension), writing (e.g., spelling and grammar
of the participants signed an Informed Consent Form (ICF) prior
accuracy), and/or mathematics (number sense, calculation, and
to study commencement.
reasoning) skills(4). The frequency of these impairments affects
approximately 5-15% of schoolchildren - reading and writing
difficulties are more frequently observed in males, whereas Table 1. Characterization of the Control and Specific Learning Disorder
(SLD) groups
mathematics disabilities are more commonly found in females(5).
Characteristics SLD (n=29) control (N=29)
This diagnosis should be conducted by a multidisciplinary team
Age in years (min-max) 8-13 8-13
through systematic assessment of the skills involved, analysis
Female n (%) 11 (37.9%) 11 (37.9%)
of school learning opportunities, chronological age, history of Male n (%) 18 (62.1%) 18 (62.1%)
failure, school curriculum, and intervention without response
in the short or medium term(6,7).
Etiological basis is influenced by genetics(8) and other
correlated facts (e.g., overall health, behavior, and sleep) which Selection criteria
can aggravate the clinical condition and be determinant for
definition of the work team, therapeutic planning, and success Inclusion criteria for the SLD group were as follows:
of Speech-language Pathology treatment in these cases(9-11). schoolchildren of both sexes with a Speech-language Pathology
Sleep is a physiological process that can knowingly influence diagnosis of SLD according to the definition, diagnostic
various behavioral aspects, such as hyperactivity, mood, and characteristics, and classification of the Fifth Edition of the
aggressiveness(9,10), as well as cognitive functions in children Diagnostic and Statistical Manual of Mental Disorders (DSM-5)(3).
and adolescents(12). Attention and memory, which are extremely Individuals underwent multidisciplinary diagnoses encompassing
important aspects in the development of spoken or written speech-language, neuropsychological and pedagogical aspects in
language, may also be negatively influenced by partial or total a public university located in the countryside of Sao Paulo state
sleep deprivation(11). Studies conducted with children with sleep conducted in three stages: (1) Clinical history; (2) Evaluation
disorders have reported cognitive and learning deficits(13,14). based on the Descriptive Mapping of Child Speech-language
In addition to sleep deprivation impair language processing Pathology Assessment(18) and application of a School Performance
and school performance; several studies have demonstrated Test (SPT)(19) comprising three subtests: Writing, Reading,

Franklin et al. CoDAS 2018;30(3):e20170104 DOI: 10.1590/2317-1782/20182017104 2/8

Arithmetic, and related assessments; and (3) Interview with description of parents and/or guardians about the behavior of
teacher. their children(21).
To receive a diagnosis of SLD, individuals had to present Scores obtained in the CBCL items were converted into a
the following conditions in varying degrees: “T” score for data analysis and classified into 11 behavioral
scales: anxiety; depression; somatic complaints; social,
(1) Clinical history: presence of history of language impairments
thinking and attention problems; delinquency; aggressiveness;
prior to literacy initiation; history of difficulty in narrating
externalizing and internalizing scales; total score of behavior
stories and learning the letter-sound correspondence.
problems. The behavioral profile of each individual, classified
(2) Speech-language Pathology and related assessments - to into clinical, borderline and non-clinical scales, was drawn using
be included in the SLD Group, individuals should necessarily the Assessment Data Manager (ADM) software.
present impairments as follows:
Sleep Diary
In reading skills such as discriminating between letters
and numbers; identifying correspondence between letters This instrument is composed of six items that should be
of the alphabet and their respective names and between observed and noted by parents and/or guardians over a five-day
spoken and written words; reading of words and phrases; period: bedtime, wake up time, hours slept, sleep state during
reading comprehension of sentences and/or small texts; the day, mood at waking up, and nocturnal awakenings.
In writing skills such as copying, writing under dictation of
Sleep Disturbance Scale for Children (SDSC)
sentences and small texts, spelling, mathematical‑numeric
and arithmetic skills (i.e., difficulty in identifying The Brazilian version(22) of this instrument was used in the
relationship between quantity and numeral); identifying present study. It comprises 26 items for evaluation of sleep
mathematical relationships between quantities (e.g., of in children and adolescents with indication of six factors of
equivalence, order, different from..., larger and smaller sleep disorders, namely, disorder of initiating or maintaining
than...); understanding and solving simple arithmetic sleep (DIMS); sleep breathing disorders (SBD); disorders
problems; of arousal/nightmares (DA); sleep-wake transition disorders
In logical-mathematical reasoning (organizing, planning (SWTD); disorders of excessive somnolence (DES); sleep
and performing calculations). hyperhidrosis (SHY), and a sleep disturbance total score (TS).
(3) Information provided by the teacher: difficulty in the three Statistical analysis
academic skills involved: reading, writing, and mathematics,
for a certain time, even after pedagogical intervention Descriptive analysis was performed to demonstrate
conducted in the school (e.g., tutoring). dispersion of the data as mean, standard error of the mean (SE),
and percentage. Analysis of Variance (ANOVA) was used for
Dyslexic individuals that presented impairment in reading
comparison between the groups, whereas the Spearman’s rank
and writing, but typical performance in logical-mathematical
correlation coefficient was used for correlation of the data.
reasoning were excluded from the study sample.
Inclusion criteria for the Control Group were as follows:
RESULTS
individuals in the same age range of those in the SLD,
matched for sex, with absence of school complaint, adequate
Assessment of routines, general health, daily activities, and
performance in reading, writing, and mathematics according to
sleep environment showed that 34.5% of the individuals in the
age and schooling, and absence of history of psychiatric and
SLD Group reside with more than four people, which did not
neurological disorders.
significantly differ from individuals in the Control Group (37.9%).
Assessment instruments No difference was also observed between the groups regarding
room sharing (Table 2). With respect to health problems, feeding
General Sleep Habits Questionnaire routine, use of medication, and medical or therapeutic treatment,
individuals in the SLD presented higher percentages compared
In this study, a version of this instrument adapted and with those in the Control Group (Table 2). The parents and/or
validated by Belisio(20) was used, to which information on bedtime guardians of 34.5% of the individuals in the SLD reported
behavior, type of school, and study routine was added, resulting
that their children present poor quality of sleep, whereas this
in 35 questions: 19 questions on routines, four on health, five
percentage was 6.9% in the Control Group (Table 2). Percentages
on daily activities, and six on sleep environment.
of family members with sleep problems and individuals who
Child Behavior Checklist (CBCL) doze during the day and have difficulty waking up in the morning
were higher in the SLD than in the Control Group (Table 2).
The Brazilian version of this behavior inventory was used in this As for breathing aspects, the SLD presented higher percentage
study - Child Behavior Checklist for ages 6-18 and 4-18 (CBCL), of snoring, bruxism, and obstructive sleep apnea compared with
whose objective is to register, in a standardized way, the the Control Group (Table 2). Regarding behavior during sleep,

Franklin et al. CoDAS 2018;30(3):e20170104 DOI: 10.1590/2317-1782/20182017104 3/8

48.3% and 24.1% of the individuals in the SLD and Control Comparison of time until sleep onset between the groups
Group, respectively, talk in their sleep (Table 2). showed that the SLD presented longer sleep latency in minutes
The average number of hours of sleep per night on weekdays compared with that of the Control Group 13.0 ± 1.7 min and
in the SLD (9.3h ± 0.3h) did not differ significantly from that in 8.8 ± 1.1 min, respectively (p = 0.01) (Figure 1B).
the Control Group (8.6h ± 0.2h). In contrast, individuals in the Regarding sleep disorders, according to the Sleep Disturbance
Control Group presented higher mean number of hours of sleep Scale for Children (SDSC), 65.5% of the individuals in the SLD
in the weekend (9.9h ± 0.3h; p = 0.0008) than on weekdays. presented symptoms of sleep disturbance, with sleep-wake
Bedtime and wake up time in the SLD did not differ from those in transition disorders (SWTD) (51.7%) most frequently observed,
the Control Group on weekdays or in the weekend (Figure 1A); followed by sleep disturbance total score above acceptable
however, individuals in both groups went to bed later and slept (41.4%) (Table 3). Individuals in the Control Group showed
in during the weekend (Figure 1A). no symptoms of sleep disorders.

Table 2. Quality-of-sleep influencing aspects in the Control and Specific Learning Disorder (SLD) groups
Characteristics % SLD % control
Live with more than four people 34.48 (N=10) 37.93 (N=11)
Room sharing 44.83 (N=13) 48.27 (N=14)
Report poor quality of sleep 34.48 (N=10) 6.89 (N=2)
Present health problems 41.37 (N=12) 0
Make use of continuous medication 51.72 (N=15) 0
Undergo medical treatment/therapy 41.37 (N=12) 6.89 (N=2)
Snore 51.72 (N=15) 20.68 (N=6)
Grind the teeth 48.27 (N=14) 17.24 (N=5)
Talk during sleep 48.27 (N=14) 24.13 (N=7)
Constantly change position during sleep 68.96 (N=20) 51.72 (N=15)
Wake up from sleep screaming 24.13 (N=7) 0
Sleepwalk 24.13 (N=7) 0
Have family members with sleep problems 55.17 (N=16) 24.13 (N=7)
Doze during the day 48.27 (N=14) 20.68 (N=6)
Drink coffee, tea, or soda 100 100
Present difficulty waking up in the morning 48.27 (N=14) 24.13 (N=7)
Complain about apnea 34.48 (N=10) 0
Caption: Percentage (%) of individuals who presented each parameter analyzed on routines, health, daily activities, and sleep environment of the Sleep Language
Disorders (N=29) and Control (N=29) groups

Caption: In A, mean ± standard error of the mean (SEM) of the bed and wake up times of individuals on weekdays and weekends; # means weekdays ≠ weekends;
p<0.05. In B, mean ± standard error of the mean (SEM) of the time elapsed for individuals to initiate sleep (sleep latency); * means SLD ≠ control; p<0.05. In C, percentage
of individuals in both groups who had disorders in the initiation of sleep, disorders of excessive somnolence, and night wakings; N = 29 per group
Figure 1. Sleeping habits of individuals in the Specific Learning Disorder (SLD) and Control (CG) group

Franklin et al. CoDAS 2018;30(3):e20170104 DOI: 10.1590/2317-1782/20182017104 4/8

 Analysis of behavior of the participants using the Child the total score of behavioral problems presented percentages of
Behavior Checklist (CBCL) showed that 72.4% of the individuals 58.6%, 48.3%, and 62.1%, respectively, in the SLD.
in the SLD had a clinical condition of behavioral problems in Correlation analyses between sleep disorders and behavioral
at least one of the classifications of this inventory. No clinical problems in the SLD showed association of sleep disturbances
conditions were found for behavioral problems in the Control (DIMS, disorder of initiating or maintaining sleep; SBD, sleep
Group. breathing disorders; DA, disorders of arousal/nightmares;
In the SLD, among the clinical scales of behavioral problems, SWTD, sleep-wake transition disorders; DES, disorders of
27.5% of the individuals were classified with anxiety, 27.5% excessive somnolence; SHY, sleep hyperhidrosis) and the sleep
with depression, 20.7% with somatic problems, 37.9% with disturbance total score (TS) with problems of anxiety; depression;
social problems, 41.3% with thinking problems, 55.2% with somatic complaints; social, thinking and attention impairments;
attention problems, 24.1% with delinquency, and 31% with delinquency; aggressiveness; externalizing and internalizing
aggressiveness. The externalizing and internalizing scales and scales; total score of behavior problems (Figures 2-4).

Table 3. Sleep disorders in children and adolescents with Specific Learning Disorder (N=29)
DIMS SBD DA SWTD DES SHY TS
% of individuals with a score above acceptable 24.1 37.9 13.8 51.7 0 34.5 41.4
Caption: DIMS = disorder of initiating or maintaining sleep; SBD = sleep breathing disorders; DA = disorders of arousal/nightmares; SWTD = sleep-wake transition
disorders; DES = disorders of excessive somnolence; SHY = sleep hyperhidrosis; TS = sleep disturbance total score

Caption: From A-K, correlations between disorder of initiating or maintaining sleep (DIMS) and behavior problems of anxiety (A); depression (B); somatic complaints
(C); social problems (D); thought problems (E); attention problems (F); delinquent behavior (G); aggressive behavior (H); internalizing problems (I); externalizing
problems (J); total score of behavior problems (K). From L-V, correlations between sleep breathing disorder (SBD) and behavior problems of anxiety (L); depression
(M); somatic complaints (N); social problems (O); thought problems (P); attention problems (Q); delinquent behavior (R); aggressive behavior (S); internalizing problems
(T); externalizing problems (U); total score of behavior problems (V); In W, correlation between disorders of arousal (DA) and anxiety; in X correlation between disorders
of arousal (DA) and depression; N=29
Figure 2. Correlation between sleep disorders and behavior problems in individuals with specific learning disorder – Part 1

Franklin et al. CoDAS 2018;30(3):e20170104 DOI: 10.1590/2317-1782/20182017104 5/8

Caption: From A-I, correlations between disorders of arousal (DA) and behavior problems of somatic complaints (A); social problems (B); thought problems (C);
attention problems (D); delinquent behavior (E); aggressive behavior (F); internalizing problems (G); externalizing problems (H); total score of behavior problems (I).
From J-T, correlations between sleep-wake transition disorders (SWTD) and anxiety (J); depression (K); somatic complaints (L); social problems (M); thought problems
(N); attention problems (O); delinquent behavior (P); aggressive behavior (Q); internalizing problems (R); externalizing problems (S); total score of behavior problems
(T). From U-X, correlations between disorders of excessive (DES) and anxiety (U); depression (V); somatic complaints (W); social problems (X); N= 29
Figure 3. Correlation between sleep disorders and behavior problems in individuals with specific learning disorder – Part 2

Caption: From A-G, correlations between disorders of excessive somnolence (DES) and thought problems (A); social problems (B); attention problems (C) delinquent
behavior (D); aggressive behavior (E); externalizing problems (F); internalizing problems (G). From H-R, correlations between sleep hyperhidrosis (SHY) and anxiety (H);
depression (I); somatic complaints (J); social problems (K); thought problems (L); attention problems (M); delinquent behavior (N); aggressive behavior (O); internalizing
problems (P); externalizing problems (Q); total score of behavior problems (R). From S-AD, correlations between sleep disturbance total score (TS) and anxiety (S);
depression (T); somatic complaints (U); social problems (V); thought problems (W); attention problems (X); delinquent behavior (Y); aggressive behavior (Z); internalizing
problems (AB); externalizing problems (AC); total score of behavior problems (AD); N= 29
Figure 4. Correlation between sleep disorders and behavior problems in individuals with specific learning disorder – Part 3

Franklin et al. CoDAS 2018;30(3):e20170104 DOI: 10.1590/2317-1782/20182017104 6/8

DISCUSSION CONCLUSION

Results of the present study showed that individuals with Individuals with specific learning disorder show high rates
specific learning disorder (SLD) (65.5%) presented higher of sleep disturbance, mainly wakefulness-sleep transition, and
percentages of sleep disturbance compared with those of show high rates of attention problems. The worse the sleep
individuals with typical development assessed in this and other disorders, the worse the behavioral aspects in these individuals.
studies (up to 40%)(23,24).
Considering that sleep plays an essential role in the processes ACKNOWLEDGEMENTS
of attention, memory formation, and brain plasticity and
maturation, the data of this study emphasize the importance The authors are grateful to Fundação de Amparo à Pesquisa
of investigating the quality of sleep and its disorders in do Estado de São Paulo (FAPESP) proc. no. 11/51495-4 and
conditions involving deficits in neural processes(9,12), such as Programa Institucional de Bolsas de Iniciação Científica from
SLD(12). Assessment and treatment of sleep disorders prior to Conselho Nacional de Desenvolvimento Científico e Tecnológico
or concurrently with Speech‑language Pathology intervention (CNPq) proc. no. 26212/2013 for funding this study.
may result in improvement in behavior, school performance,
and quality of life(15,17). REFERENCES
The SLD group presented higher percentages of individuals
1. ASHA: American Speech-Language-Hearing Association. Definitions of
who wake up during the night and experience difficulties communication disorders and variations [Internet]; Rockville, Maryland,
going back to sleep, snore, grind their teeth, constantly change EUA; ASHA; 1993 [cited 2017 May 4]. Available from www.asha.org/
position during sleep, talk and/or walk in their sleep, and present policy
symptoms of sleep obstructive apnea compared with those of 2. Saur D, Schelter B, Schnell S, Kratochvil D, Küpper H, Kellmeyer P, et al.
individuals in the Control Group. Combining functional and anatomical connectivity reveals brain networks
for auditory language comprehension. Neuroimage. 2010;49(4):3187-97.
An important component of this evaluation, in addition to
http://dx.doi.org/10.1016/j.neuroimage.2009.11.009. PMid:19913624.
the description of quality of sleep, is the identification of the
3. American Psychiatric Association. Diagnostic and statistical manual of
subtypes of sleep disorders present(25). The sleep disturbances mental disorders: DSM-5. 5. ed. Arlington: American Psychiatric Association;
most frequent found in the SLD were sleep-wake transition 2013. 991 p.
disorders (SWTD), sleep breathing disorders (SBD), sleep 4. Moll K, Kunze S, Neuhoff N, Bruder J, Schulte-Ko¨rne G. Specific learning
hyperhidrosis (SHY), and disorder of initiating or maintaining disorder: prevalence and gender differences. PLoS One. 2014;9(7):e103537.
sleep (DIMS), as well as sleep disturbance total score (TS) above http://dx.doi.org/10.1371/journal.pone.0103537. PMid:25072465.
acceptable. Disorders of excessive somnolence (DES) was not 5. Schirmer C, Fontoura DR, Nunes ML. Distúrbios da aquisição da linguagem
e da aprendizagem. J Pediatr. 2004;80(2):S95-103. http://dx.doi.org/10.1590/
present in this population probably due to the fact that 48% S0021-75572004000300012.
of individuals doze during the day and 100% drink stimulant
6. Silver CH, Ruff RM, Iverson GL, Barth JT, Broshek DK, Bush SS, et al.
beverages such as coffee and soda, which may mask excessive Learning disabilities: the need for neuropsychological evaluation. Arch
daytime somnolence. Clin Neuropsychol. 2008;23(2):217-9. http://dx.doi.org/10.1016/j.
SBD symptoms in the SLD corroborate the hypothesis reported acn.2007.09.006. PMid:17977692.
in previous studies that changes in the respiratory pattern can 7. Pham AV, Riviere A. Specific learning disorders and ADHD: current issues
lead to nocturnal sleep fragmentation - altering its cycle, and in diagnosis across clinical and educational settings. Curr Psychiatry Rep.
2015;17(6):38. http://dx.doi.org/10.1007/s11920-015-0584-y. PMid:25894357.
affect language development and academic performance(26,27).
8. Deriziotis P, Fisher SE. Speech and language: Translating the genome. Trends
Regarding behavior analysis, the present study showed high Genet. 2017;33(9):642-56. http://dx.doi.org/10.1016/j.tig.2017.07.002.
prevalence of altered behaviors in the SLD, with emphasis on PMid:28781152.
attention problems. Previous studies have reported correlation 9. O’Brien LM, Gozal D. Neurocognitive dysfunction and sleep in children:
between reading impairment and behavioral problems(28,29). from human to rodent. Pediatr Clin North Am. 2004;51(1):187-202. http://
This study added data to this discussion also demonstrating that dx.doi.org/10.1016/S0031-3955(03)00184-6. PMid:15008589.
specific sleep disorders are associated with behavioral changes 10. Zuculo GM, Knap CC, Pinato L. Correlation between sleep and quality
of life in cerebral palsy. CoDAS. 2014;26(6):447-56. http://dx.doi.
in SLD. In this case, the worse the sleep disturbances, the worse
org/10.1590/2317-1782/20140201435. PMid:25590906.
the behavioral problems observed. This finding reinforces the
11. Blissitt PA. Sleep, memory, and learning. J Neurosci Nurs. 2001;33(4):208-
hypothesis that sleep disturbance could negatively influence 15. http://dx.doi.org/10.1097/01376517-200108000-00007. PMid:11497074.
the characteristics of this condition, especially behavior. 12. Engle-Friedman M, Riela S, Golan R, Ventuneac AM, Davis CM,
Correlation between sleep and behavioral changes has been Jefferson AD, et al. The effect of sleep loss on next day effort. J Sleep Res.
described in several conditions, such as autism(30), attention deficit 2003;12(2):113-24. http://dx.doi.org/10.1046/j.1365-2869.2003.00351.x.
hyperactivity disorder (ADHD), and even in schoolchildren with PMid:12753348.
typical development(31), with improved behavior observed after 13. Rhodes SK, Shimoda KC, Waid LR, O’Neil PM, Oexmann MJ, Collop
NA, et al. Neurocognitive deficits in morbidly obese children with obstructive
treatment of sleep disorders(17,25). sleep apnea. J Pediatr. 1995;127(5):741-4. http://dx.doi.org/10.1016/S0022-
This two-way correlation indicates that the investigation 3476(95)70164-8. PMid:7472827.
of sleep patterns and behavior in SLD can be beneficial to 14. Owens J, Spirito A, Marcotte A, Mcguinn M, Berkelhammer L.
Speech‑language Pathology treatment. Neuropsychological and behavioral correlates of obstructive sleep apnea

Franklin et al. CoDAS 2018;30(3):e20170104 DOI: 10.1590/2317-1782/20182017104 7/8

 syndrome in children: a preliminary study. Sleep Breath. 2000;4(2):67-78. 25. Wiggs L, Stores G. Sleep patterns and sleep disorders in children with
http://dx.doi.org/10.1007/BF03045026. PMid:11868122. autistic spectrum disorders: insights using parent report and actigraphy.
15. Kaemingk KL, Pasvogel AE, Goodwin JL, Mulvaney SA, Martinez F, Dev Med Child Neurol. 2004;46(6):372-80. http://dx.doi.org/10.1017/
Enright PL, et al. Learning in children and sleep disordered breathing: S0012162204000611. PMid:15174528.
findings of the Tucson Children’s Assessment of Sleep Apnea (TucCASA) 26. Machado Gomes A, Santos OM, Pimentel K, Marambaia PP, Gomes LM,
prospective cohort study. J Int Neuropsychol Soc. 2003;9(7):1016-26. Pradella-Hallinan M, et al. Quality of life in children with sleep-disordered
http://dx.doi.org/10.1017/S1355617703970056. PMid:14738283. breathing. Rev Bras Otorrinolaringol (Engl Ed). 2012;78(5):12-21. http://
16. Dewald JF, Meijer AM, Oort FJ, Kerkhof GA, Bogels SM. The influence of dx.doi.org/10.5935/1808-8694.20120003. PMid:23108815.
sleep quality, sleep duration and sleepiness on school performance in children 27. Fensterseifer GS, Carpes O, Weckx LLM, Martha VF. Mouth breathing
and adolescents: a meta-analytic review. Sleep Med Rev. 2010;14(3):179- in children with learning disorders. Rev Bras Otorrinolaringol (Engl
89. http://dx.doi.org/10.1016/j.smrv.2009.10.004. PMid:20093054. Ed). 2013;79(5):620-4. http://dx.doi.org/10.5935/1808-8694.20130111.
17. Gregory AM, Sadeh A. Sleep, emotional and behavioral difficulties in PMid:24141679.
children and adolescents. Sleep Med Rev. 2012;16(2):129-36. http://dx.doi. 28. Tomblin JB, Zhang X, Buckwalter P, Catts H. The association of reading
org/10.1016/j.smrv.2011.03.007. PMid:21676633. disability, behavioral disorders, and language impairment among second-
18. Giacheti CM, Ferrari C. Roteiro descritivo da avaliação fonoaudiológica grade children. J Child Psychol Psychiatry. 2000;41(4):473-82. http://
da criança. In: Giacheti CM, editor. Avaliação da fala e da linguagem: dx.doi.org/10.1111/1469-7610.00632. PMid:10836677.
perspectivas interdisciplinares. Marília: Cultura Acadêmica; 2016. 270 p. 29. Byars AW, deGrauw TJ, Johnson CS, Perkins SM, Fastenau PS, Dunn
19. Stein LM. TDE: teste de desempenho escolar: manual para aplicação e DW, et al. Language and social functioning in children and adolescents
interpretação. São Paulo: Casa do Psicólogo; 1994, 1-17. with epilepsy. Epilepsy Behav. 2014;31:167-71. http://dx.doi.org/10.1016/j.
yebeh.2013.11.007. PMid:24434307.
20. Belísio AS, Louzada FM, Azevedo CVM. Influence of social factors on
the sleep-wake cycle in children. Sleep Sci. 2010;3(2):82-6. 30. Fadini CC, Lamônica DA, Fett-Conte AC, Osório E, Zuculo GM, Giacheti
21. Bordin IA, Rocha MM, Paula CS, Teixeira MCTV, Achenbach TM, CM, et al. Influence of sleep disorders on the behavior of individuals
Rescorla LA, et al. Child Behavior Checklist (CBCL), Youth Self-Report with autism spectrum disorder. Front Hum Neurosci. 2015;18(9):347.
(YSR) and Teacher’s Report Form(TRF): an overview of the development PMid:26150777.
of the original and Brazilian versions. Cad Saude Publica. 2013;29(1):13- 31. Vélez-Galarraga R, Guillén-Grima F, Crespo-Eguílaz N, Sánchez-
28. PMid:23370021. Carpintero R. Prevalence of sleep disorders and their relationship with core
22. Ferreira VR, Carvalho LB, Ruotolo F, de Morais JF, Prado LB, Prado GF. symptoms of Inattention and hyperactivity in children with attention-deficit/
Sleep disturbance scale for children: translation, cultural adaptation, and hyperactivity disorder. Eur J Paediatr Neurol. 2016;20(6):925-37. http://
validation. Sleep Med. 2009;10(4):457-63. http://dx.doi.org/10.1016/j. dx.doi.org/10.1016/j.ejpn.2016.07.004. PMid:27461837.
sleep.2008.03.018. PMid:18706856.
23. Hochadel J, Frölich J, Wiater A, Lehmkuhl G, Fricke-Oerkermann L. Author contributions
Prevalence of sleep problems and relationship between sleep problems AMF was responsible for the study design, collection, analysis and interpretation
and school refusal behavior in school-aged children in children’s and of the data, and writing of the manuscript; CMG participated in the study
parents’ ratings. Psychopathology. 2014;47(2):119-26. http://dx.doi. design, general orientation of its execution stages, analysis of the data and
org/10.1159/000345403. PMid:24080494. revision of the manuscript; NCS and LMGC participated in the analysis and
24. Gupta R, Bhatia MS, Chhabra V, Sharma S, Dahiya D, Semalti K, et al. Sleep interpretation of the data and writing of the manuscript; LP was responsible
patterns of urban school-going adolescents. Indian Pediatr. 2008;45(3):183- for the study design, general orientation of its execution stages, analysis and
9. PMid:18367762. interpretation of the data, and writing of the manuscript.

Franklin et al. CoDAS 2018;30(3):e20170104 DOI: 10.1590/2317-1782/20182017104 8/8