Chronobiology International, 2013; 30(7): 919–929

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ISSN: 0742-0528 print / 1525-6073 online
DOI: 10.3109/07420528.2013.790041

Association of Eveningness With Problem Behavior in Children:

A Mediating Role of Impaired Sleep

Kristiaan B. van der Heijden, Leo M. J. de Sonneville, and Hanna Swaab

Department of Clinical Child and Adolescent Studies, Leiden Institute for Brain and Cognition, Leiden University,
Leiden, The Netherlands
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Eveningness, the preference of being active during the evening in contrast to the morning, has been associated with
markedly increased problem behavior in adolescents; however, the underlying mechanisms are still not understood.
This study investigates the association of eveningness with behavior and cognition in children aged 7–12 yrs, and
explores the potential mediating role of a variety of sleep factors. Parents of 333 school-aged children (mean
age ¼ 9.97 yrs; 55% girls) completed a sleep log and several questionnaires regarding eveningness, sleep habits, and
behavioral problems. Intellectual abilities, working memory, and attention were assessed using the short-form of the
Wechsler Intelligence Scale for Children (WISC) and subtasks of the Amsterdam Neuropsychological Tasks. Results
showed that eveningness predicted behavioral problems over and above the effects of demographic variables (age,
sex, and familial socioeconomic status) (p ¼ 0.003). Significant partial correlation was found for eveningness and sleep
duration during weekdays (p ¼ 0.005), and not during weekends. Furthermore, evening orientation was associated
with a reduced rested feeling on weekday mornings (p50.001), but not on weekends. The most important sleep
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characteristic showing association with many cognitive and behavioral measures was the subjective feeling upon
awakening—particularly during weekdays. Bootstrap mediation analyses demonstrated that sleep significantly
mediated the effects of eveningness on behavioral problems, working memory, and sustained attention. Interestingly,
mediation was only significant through the subjective feeling upon awakening on weekdays. The current findings
indicate that the subjective feeling upon awakening is a much better predictor of daytime problems than subjective
sleep quantity. Furthermore, the data suggest that negative outcomes in evening types are due to the fact that they
wake up before their circadian drive for arousal and prior to complete dissipation of sleep pressure during weekdays.
Interventions that target the misalignment of endogenous circadian rhythms and imposed rhythms are discussed.
(Author correspondence: kbheijden@fsw.leidenuniv.nl)
Keywords: Attention, behavior, chronotype, circadian rhythm, cognition, eveningness, sleep, working memory

INTRODUCTION
Human individuals show variation in the preference of
being physically and mentally active during a specific
period within the 24-h day (Adan et al., 2012). The
inclination to become more active either at dawn or at
dusk can be quantified on a morningness-eveningness
scale. Based upon this propensity, individuals can be
classified into chronotypes (i.e., morning, evening, and
neither types), although consensus criteria to classify
children are still lacking. Half of the variance in circa-
dian preference is genetically determined (Hur, 2007),
and the trait remains considerably stable during human
development despite marked shifts towards eveningness
during early adolescence (Carskadon et al., 1993).
Physiologically, eveningness is related both to slow
homeostatic processes that regulate the buildup and
dissipation of sleep pressure during the respective
wakeful and sleep periods, and to a longer circadian
period driven by the biological clock in the brain
(Phillips et al., 2010).
Recent research has demonstrated an intriguing link
between eveningness and behavioral problems. Several
13
20
studies found increased rates of behavioral and emo-
tional problems, suicidality, and substance use in
adolescents with evening preference compared with
intermediate and morning groups (Gau et al., 2007;
Goldstein et al., 2007; Lange & Randler, 2011). Other
studies demonstrated worse academic performance in
evening-type adolescents compared with morning and
intermediate types (Besoluk et al., 2011; Giannotti et al.,
2002; Randler & Frech, 2009; Taylor et al., 2011),
although performance decrements in evening types are

Submitted October 24, 2012, Returned for revision February 27, 2013, Accepted March 2, 2013
Address correspondence to Kristiaan B. van der Heijden, Department of Clinical Child and Adolescent Studies, Leiden University,
Wassenaarseweg 52, Box 9555, 2300 RB Leiden, The Netherlands. Tel.: +31715276628; E-mail: kbheijden@fsw.leidenuniv.nl

919
 920 K. B. van der Heijden et al.
markedly reduced when tested at optimal times of the
day (i.e., afternoon) (Hahn et al., 2012). To date, little
effort has been put into a better understanding of the
nature of this relation, which is surprising because
insight into this important subject might help to
improve public health. Since the individual’s position
within the morningness-eveningness spectrum has
important implications for its sleep characteristics,
sleep curtailment is a likely candidate to mediate the
association between eveningness and behavioral prob-
lems. Studies have shown that during school days, sleep
onset in evening-type children is generally almost 1 h
later than in morning types, whereas differences in
wake-up time are absent due to fixed school schedules
(Giannotti et al., 2002; Russo et al., 2007). During free
days, a marked delay both in sleep onset and awake time
can be seen (Russo et al., 2007), which is much more in
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line with their endogenous circadian rhythm. As a result,
evening types show a shorter sleep duration than
morning types during school days. This large discrep-
ancy in bedtimes between week- and free days leads to
irregular sleep-wake rhythms. The fact that both sleep
quantity and sleep quality are compromised (Russo
et al., 2007), and that daytime sleepiness is higher in
evening types (Tonetti et al., 2012), raises the question to
what extent each dimension of sleep contributes to the
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increase in behavioral problems.
A wealth of experimental, cross-sectional, and longi-
tudinal studies has shown that sleep loss in children
leads to behavioral problems and cognitive deficits
across a wide variety of domains (Astill et al., 2012).
This does not only hold for sleep quantity, but also sleep
quality such as expressed in sleep efficiency, sleep
latency (Komada et al., 2011; Taylor et al., 2008; Yang &
Spielman, 2001), and the regularity of the sleep-wake
rhythm (Manber et al., 1996; Takasu et al., 2012) have
shown association with increased sleepiness, tension,
anxiety, anger, hostility, and other internalizing and
externalizing behavioral problems. Studies have sug-
gested that impaired sleep might have long-lasting
effects on behavior, of which the residual effects can be
noticed even years after normalization of sleep. For
instance, in a longitudinal study, Touchette and col-
leagues (2007) found that relatively short sleep duration
before the age of 41 months is associated with exter-
nalizing problems such as hyperactivity and lower cog-
nitive performance several years later in development.
Similarly, Friedman and colleagues (2009) published
longitudinal data revealing that individual differences in
developmental patterns of sleep problems from the age
of 4 yrs to 16 yrs are associated with executive control in
late adolescence. These findings indicate that timely
normalization of sleep might work as a preventive
measure for behavioral deficits later in development.
The current study is a first attempt to clarify the
relation between eveningness and behavioral problems
in children. The central questions are the following:
Which aspects of cognition and behavior are associated
with eveningess, and how is sleep involved in these
potential associations? Eveningness is expected to
unfavorably affect externalizing and internalizing
behavioral problems and performance on tasks of
intellectual abilities, attention, and working memory.
Furthermore, it is hypothesized that both sleep quantity
and sleep quality mediate this association.
METHODS
Participants
The sample consisted of 333 children (mean age ¼ 9.97
yrs; SD ¼ 1.50; 55.4% girls) from both urban and rural
areas in The Netherlands. An average score of educa-
tional level of the parents served as indicator of
socioeconomic status. This score was based upon the
scores of both the father and the mother on a 5-category
response scale: (a) no education, (b) primary, (c) lower
secondary, (d) higher secondary, and (e) tertiary. Eighty
percent of the parents had completed at least higher
secondary school. Most parents were born in The
Netherlands (82%), Surinam (4%), or Turkey (2%).
Three children were excluded from the sample based
on their estimated full-scale IQ (570). All parents gave
written informed consent. Ethical approval was given by
the institutional review board of Leiden University, and
the experimental protocol conforms to international
ethical standards as outlined by Portaluppi et al. (2010).
Procedures
Parents were approached with information letters via
primary schools in both urban and rural areas in The
Netherlands. After having provided written informed
consent, parents filled out questionnaires on back-
ground information, morningness-eveningness score,
and behavioral problems of their children. After having
received the completed questionnaires, the participants
were allocated to one of three clock times (early
morning, late morning, and early afternoon) at which
administration of cognitive ability tests (subtests of the
Wechsler Intelligence Scale for Children [WISC]-III and
Amsterdam Neuropsychological Tasks; for details on
tests, see Instruments) took place, in order to avoid
time-of-day effects. Allocation was done using ‘‘ran-
domization by minimization,’’ which is a randomization
process that balances for important factors, in this case:
(1) age group (7–9 and 10–12 yrs) and (2) chronotype
(morning type, evening type, neither). Thus, within both
age groups there was an even distribution of each
chronotype over the three test sessions. Furthermore,
parents were asked to fill in a sleep problem question-
naire and to keep a structured pediatric sleep diary for
the duration of 1 wk.
Tests of cognitive ability were administered individu-
ally by trained undergraduate child psychologists (dur-
ation 60 min) in a separate room at the child’s school,
during the week in which parents filled out the sleep
diary. Intellectual ability was estimated by means of two
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subtests (Vocabulary and Block design) of the Wechsler
Intelligence Scale for Children-III (WISC-III; Kort et al.,
2005). Information processing was assessed with four
subtests of the Amsterdam Neuropsychological Tasks
(ANT) (De Sonneville, 1999; De Sonneville et al., 2002).
Test order was counterbalanced by random allocation to
two different series. Verbal task instructions were given,
emphasizing both speed and accuracy of performance.
Practice trials were included for each task. The test
sessions took place on weekdays (Tuesday, Thursday, or
Friday) during the months February to June 2010.
Instruments
Morningness-Eveningness
Eveningness of the children was assessed with a Dutch
translation of the Children’s Chronotype Questionnaire
(CCTQ) (Werner et al., 2009) completed by parents. The
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morningness-eveningness subscale consists of 10 state-
ments about the child’s time-of-day preference for
certain activities and about waking in the morning,
based on the preceding weeks. Scores are summed,
yielding a continuous variable ranging from 10 to 48,
with higher scores indicating increased eveningness.
Classification into chronotypes was not possible
because normative data were not available for the
Dutch population. Therefore, the continuous variable
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Total CCTQ score was used in the analyses.
Psychometric properties of the original CCTQ were
shown to be adequate (Werner et al., 2009). Cronbach’s
alpha of the Dutch version was 0.78.
Behavioral Problems
The Child Behavioral Checklist (CBCL; 4–18 yrs) is a
parent-report questionnaire containing 113 items
assessing a broad range of emotional and behavioral
problems in children (Achenbach, 1991; Verhulst et al.,
1996). Several scores can be derived from the question-
naire, such as internalizing and externalizing problems
(broadband scales), total problems, and several sub-
scales clustering specific problems (narrowband scales).
In the present study, standardized T-scores (by age and
sex) of the two broadband scales and the total problem
scores were used, as well as the raw total score of the
attention problems subscale. The Dutch translation of
the CBCL was found to have good reliability and validity
in the Dutch population (Verhulst et al., 1996).
Cronbach’s alpha in the current sample was 0.94.
Sleep Problems
The Children’s Sleep Habits Questionnaire is a parent
questionnaire for children aged 4 to 12 yrs, to screen for
common sleep problems (Owens et al., 2000). The total
sleep disturbance score is formed by the scores on 33
items, each having a 3-point response scale (1–3). A
higher score on the total scale is indicative of more sleep
problems. In a large sample of school-aged children,
good psychometric properties were found (Owens et al.,
2000). Cronbach’s alpha in the present sample was 0.97.
! Informa Healthcare USA, Inc.
Eveningness, Sleep, and Problem Behavior in Children 921
Sleep Diary
The sleep diary was filled out during 1 wk. Parents had
to write down the time at which lights went out, the time
it took the child to fall asleep, and waking time in the
morning. From these data, sleep duration during each
night was calculated and, subsequently, mean sleep
duration was determined for weekdays and weekends
separately. Of the parents, 64.0% completed a full 7-d
diary, 2.1% of the diaries contained weekday sleep only,
and 14.1% reported some weekday and some weekend
sleep but not the full 7 d. Midsleep point was defined as
the midpoint between falling asleep and waking in the
morning, expressed in hh:mm, and was calculated
separately for weekdays and weekends. Midsleep point
has shown to be the most reliable (subjective) marker of
the circadian phase that can be derived from sleep
measurements (Werner et al., 2009). Eveningness indeed
significantly correlated with midsleep point during
weekdays (r ¼ 0.473, p50.001) and weekends
(r ¼ 0.363, p50.001), taking the demographic variables
(age, sex, and familial socioeconomic status) into
account. Moreover, the phase angle (i.e., time interval)
between midsleep point during weekends (free-running
rhythm) and waking time on weekdays was calculated,
which reflects the misalignment between sleep-wake
rhythm during school days and internal circadian
rhythm (short phase angle means that time of awaken-
ing occurs relatively early in reference to the individual’s
endogenous circadian rhythm). Phase angle correlated
significantly with eveningness (r ¼ 0.284, p50.001).
To assess instability in midsleep point, the mean
standard deviation during 1 wk of sleep was derived.
Only participants having data on three or more nights
were included to calculate instability, which led to the
exclusion of one participant on this variable. Moreover,
parents evaluated daily how rested the child felt upon
waking up (5-point scale), a variable that was included
in the analyses as a subjective measure of sleep quality.
Sleep-wake stability and the rested feeling upon
waking up are both considered aspects of sleep quality
(Yi et al., 2006).
The data from the sleep diary correlated highly with
retrospective items on usual weekday and weekend
bedtimes in the sleep habits questionnaire CSHQ, both
for school days (r ¼ 0.834, p50.001) and for the weekend
(r ¼ 0.611, p50.001). Hence, for further analyses, the
prospective sleep log variables were used.
Intellectual Abilities
To estimate the intellectual abilities, a short version of
the Wechsler Intelligence Scale for Children—Third
Edition (WISC-III; Kort et al., 2005) was used, including
Block Design, where children put together blocks in a
pattern according to a displayed model, and Vocabulary,
in which children are asked to define orally presented
words. These subtests correlate within the 0.90 range
with full-scale IQ (Sattler & Saklofske, 2001). Block
Design was included in the present study as a measure
 922 K. B. van der Heijden et al.
of nonverbal intellectual ability, and Vocabulary as a
measure of verbal intellectual ability.
Information Processing
Information processing was assessed using the
Amsterdam Neuropsychological Tasks (De Sonneville,
1999). Simple reaction time was assessed with the
Baseline Speed task, a task that has been used also by
others as a measure of intensity (alertness) of attention
(e.g., Konrad et al., 2004). On the screen, a (fixation)
cross is continuously projected. This cross unexpectedly
changes into a square, the imperative stimulus, at which
event the participant has to press a mouse button as fast
as possible. A variable postresponse interval is used to
ensure that the next stimulus will be presented between
500 and 2500 ms after the response. The cognitive level
of this task is therefore limited to detection of the mere
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presence of the stimulus. The task consists of a part for
the left hand and one for the right hand, each part
consisting of 32 presentations. Outcome measure used
in the current study is the mean reaction time (RT) over
both hands.
The task Sustained Attention Dots is based on a
continuous performance paradigm and assesses sus-
tained attention. A participant is presented with three,
four, or five dots on a screen and has to push a yes-
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button when four dots are displayed, and the no-button
when three or five dots are counted. The task includes
50 series, each with 12 presentations in a random order,
making the duration of the task approximately 15 to
20 min. An incorrect response is followed by an auditory
signal; see De Sonneville et al. (2002) for further details.
Outcome measures in this study are mean series
completion time, fluctuation in tempo (within-subject
SD of mean completion times of the series), and error
rate (amount of misses and false alarms), as well as
number of omissions and feedback responsiveness. This
latter parameter reflects the ability of the child to adjust
its behavior in response to feedback, and is operationa-
lized as posterror slowing. After error feedback, subjects
are expected to react more carefully and thus slower
than on other trials. Omissions are trials without a
response and indicate lapses of attention.
As a measure of focused attention and working
memory, the task Focused Attention 4 Letters was
included in the current study. Participants had to
detect memorized target consonants (part 1: one con-
sonant; part 2: three consonants) among four presented
consonants on a specific diagonal. If the target conson-
ant was present on the predetermined diagonal, the
participant had to press ‘‘yes.’’ When the target con-
sonant was not present, or present but at the wrong
place, the participant had to press ‘‘no’’; see Huijbregts
et al. (2002) for further task details. Outcome parameters
included in the current study are RT and error rate for
both part 1 and part 2. The working memory load
increases from part 1 to part 2, so increased slowing and
error rates over part 1 to part 2 indicate worse working
memory capacity.
Statistical Analysis
Univariate and hierarchical linear regression analyses
were performed to investigate the ability of eveningness
to predict cognitive performance and behavioral prob-
lems, above and beyond the effect of the demographic
variables age, sex, and socioeconomic status (SES).
Mediation analyses were conducted in order to examine
possible mediated effects between independent and
dependent variables. We tested the indirect effect of the
independent variable (eveningness) on the dependent
variables (cognitive performance and behavioral prob-
lems) through the mediators (sleep quantity and sleep
quality). A significant mediation effect is present when
the mediator reduces or eliminates the effect of the
independent variable on the dependent variables, that
is, when the difference between the direct and indirect
effects is statistically significant. Mediation analyses
were conducted using the ‘‘indirect’’ macro designed for
SPSS (Preacher & Hayes, 2008). In this analysis, 5000
bootstrapped samples were drawn with replacement
from the data set to estimate a sampling distribution for
the indirect mediation pathway (Hayes, 2009). The
bootstrapping strategy quantifies the indirect effect
and makes no assumption of multivariate normal
distribution in the sampling of indirect effects. Direct
and indirect effects and 95% confidence intervals are
reported. The indirect effect is significant if zero is not
within the confidence interval.
Previous to these analyses, data were inspected to
check for outliers, missing data, and assumptions
applying to the statistical tests used, using descriptive
statistics, scatterplots, histograms, and quantile-quan-
tile plots (Q-Q plots). Total IQ score was not included in
the analyses as covariate, given that IQ is a poorly
specified latent variable that is dependent on a range of
neuropsychological functions, and therefore as covari-
ate in this study can lead to overcorrected or erroneous
findings (Dennis et al., 2009).
Cases with outliers (z-score 4 on either a RT
parameter and/or an error parameter) were removed
per task: Baseline Speed: n ¼ 3 (1%); Focused Attention 4
Letters: n ¼ 35 (11%); and Sustained Attention Dots:
n ¼ 12 (4%). A probability level of p ¼ 0.05, two-sided,
was maintained for statistical significance. All data
analyses were performed using SPSS version 19 (SPSS,
Chicago, IL, USA).
RESULTS
Descriptive and Preliminary Analyses
Sample characteristics are provided in Table 1. Bivariate
correlations were calculated between demographic
variables, sleep, behavioral problems, and cognitive
variables. Age was significantly correlated with all
sleep-related variables (i.e., eveningness and sleep
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diary variables), except for feeling rested upon waking
up during weekdays, and to almost all reaction time
variables. Both sex and familial socioeconomic status
(parental educational level; SES) correlated with several
sleep variables, behavioral problems, and cognitive
variables. Sex was significantly related to eveningness
score. An independent-sample t test indicated that girls
(M ¼ 27.02, SD ¼ 5.74) were more evening-oriented than
Eveningness, Sleep, and Problem Behavior in Children 923
Eveningness, Cognition, and Behavioral Problems
Hierarchical regression analyses were performed to
examine the ability of morningness-eveningness to
predict CBCL total score above and beyond the effects
of demographic variables. Age, sex, and SES were forced
in the first step and eveningness score in the second step
of the analysis. Eveningness predicted behavioral prob-
lems over and above the effects of demographic
boys (M ¼ 25.06, SD ¼ 5.21; t(329) ¼ 3.20, p ¼ 0.001).
Furthermore, parents reported significantly more exter-
nalizing problems for boys (M ¼ 49.87, SD ¼ 10.01) than
for girls (M ¼ 46.82, SD ¼ 9.17; t(313) ¼ 2.82, p ¼ 0.005).
A higher SES score was associated with less behav-
variables ( ¼ 0.17, t(303) ¼ 2.95, p ¼ 0.003). This model
(F(4, 303) ¼ 5.16, p50.001) explained 5.1% of the vari-
ance in CBCL total score, which was 2.4% more than a
model with demographic variables only. Further ana-
lyses revealed that the effect of eveningness on problem
ioral problems. In addition, a higher SES score was behavior concerns internalizing ( ¼ 0.14, t(308) ¼ 2.44,
associated with less sleep during weekdays. Because of p ¼ 0.015) as well as externalizing ( ¼ 0.13, t(307) ¼ 2.29,
the potential influence of age, sex, and SES on the p ¼ 0.023) and the attention problems scale ( ¼ 0.12,
findings, all further analyses were controlled for effects t(307) ¼ 2.06, p ¼ 0.040). As for the cognitive variables,
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of these variables. Consequently, all correlation values results showed that eveningness was positively asso-
reported below are partial correlations, corrected for ciated with verbal intellectual ability ( ¼ 0.087,
age, sex, and SES. t(319) ¼ 2.01, p ¼ 0.045), but not with nonverbal intel-
lectual ability, simple reaction time, sustained attention,
focused attention, or working memory.

Eveningness and Sleep

TABLE 1. Demographics, eveningness, and behavioral Average sleep duration during school days was 608 min
characteristics.
(median ¼ 607, SD ¼ 43, range ¼ 483–715 min), which
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Characteristic Total (N ¼ 333) was similar during weekends (M ¼ 608, median ¼ 606,
Sex (% girls) 55.3 SD ¼ 48, range ¼ 463–805 min). Midsleep point during
Age (years) 9.97 (1.50) weekdays (M ¼ 2:08, SD ¼ 0:28 h) was significantly dif-
ferent from midsleep point during the weekend
SESa
No education 1% (M ¼ 2:51, SD ¼ 0:47 h; t(252) ¼ 14.32, p50.001). The
Primary education 2% instability of midsleep point during 1 wk (within-subject
Lower secondary education 16% standard deviation) ranged from 0 (stable) to 91
Higher secondary education 35% (instable) min (M ¼ 29, SD ¼ 16). Midsleep point
Tertiary education 47%
during weekdays correlated highly with sleep duration
Eveningness score 26.14 (5.59); median: 26.00
CBCL total problemsb 47.27 (10.43) during weekdays (r ¼ 0.45, p50.001) (Table 2). This
CBCL internalizing problemsb 49.49 (10.61) relationship was not significant for sleep duration and
CBCL externalizing problemsb 48.21 (9.67) midsleep point during weekends (r ¼ 0.09, p ¼ 0.152).
WISC-IIINL TIQc 103.79 (14.28) Furthermore, an association was found of sleep duration
a
Familial socioeconomic status, defined by parental educational with feeling rested upon waking up during weekdays
level. (r ¼ 0.14, p ¼ 0.030). Feeling rested upon waking up was
b
Standardized T-scores. not related to sleep duration in the weekend. Instability
c
Very short form: Block Design, Vocabulary. of midsleep point was not associated with sleep

TABLE 2. Partial correlations between eveningness and sleep characteristics.

Sleep Sleep Midsleep Midsleep Feeling rested Feeling rested Sleep
duration duration point point upon awakening upon awakening stability
weekdays weekend weekdays weekend weekdays weekend MSP

Eveningness 0.18** 0.01 0.47** 0.36** 0.33** 0.13* 0.10

Sleep duration weekdays — 0.43** 0.45** 0.30** 0.14* 0.08 0.01
Sleep duration weekend — — 0.12 0.09 0.07 0.10 0.02
Midsleep point weekdays — — — 0.59** 0.33** 0.08 0.12
Midsleep point weekend — — — — 0.21** 0.04 0.74**
Feeling rested upon — — — — — 0.60** 0.08
awakening weekdays
Feeling rested upon — — — — — — 0.09
awakening weekend

*p 5 .05; **p 5 .01.

! Informa Healthcare USA, Inc.

 924 K. B. van der Heijden et al.

duration. A significant correlation was found between
eveningness and sleep duration during weekdays
(r ¼ 0.18, p ¼ 0.005), but not during weekends.
Furthermore, eveningness was negatively associated
with feeling rested upon waking up during weekdays
(r ¼ 0.33, p50.001), but not during weekends.
Sleep, Cognition, and Behavioral Problems
Partial correlation analyses indicated that verbal intel-
lectual ability significantly and negatively correlated
with sleep duration during weekdays (r ¼ 0.23,
p50.001), with longer sleep relating to lower intellectual
ability. Verbal intellectual ability was not significantly
correlated with sleep duration during weekends
(Table 3). Nonverbal intellectual ability showed similar
associations: a significant correlation with sleep dur-
ation during weekdays (r ¼ 0.14, p ¼ 0.025), and non-
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Feeling rested upon waking up during weekdays was
significantly and negatively correlated with sustained
attention reaction time (r ¼ 0.18, p ¼ 0.010) and stabil-
ity in reaction time (r ¼ 0.19, p ¼ 0.009), and with
working memory reaction time (r ¼ 0.15, p ¼ 0.041),
with a more rested feeling signifying faster responses on
the tasks.
Behavioral problems (CBCL total score) were signifi-
cantly and negatively correlated with feeling rested
upon waking up both during weekdays (r ¼ 0.24,
p50.001) and weekends (r ¼ 0.20, p ¼ 0.002), indicat-
ing that a more rested feeling after awakening relates
to less problem behavior. Similarly, internalizing
problems were related to feeling rested upon waking
up both during weekdays (r ¼ 0.19, p ¼ 0.003) and
weekends (r ¼ 0.16, p ¼ 0.015). Externalizing problems
were correlated with feeling rested upon waking up

significance for weekend sleep duration. Working
memory errors correlated significantly and positively
with sleep duration during weekdays (r ¼ 0.18,
p ¼ 0.007), and during weekends (r ¼ 0.16, p ¼ 0.019).
As for the behavioral problem scales, no significant
partial correlations were found with sleep duration
variables.
Reaction time on the Baseline Speed task was
significantly and negatively correlated with feeling
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during weekdays (r ¼ 0.19, p ¼ 0.004) and weekends
(r ¼ 0.18, p ¼ 0.005), and attention problems with
feeling rested upon waking up during weekdays
(r ¼ 0.17, p ¼ 0.010).
Mediation
Sleep as Mediator Between Eveningness
and Behavioral Problems
Eveningness was included as independent variable (X),

rested upon awakening on weekend mornings (feeling behavioral problem scores as dependent variables (Y),
more rested indicating faster responses) (r ¼ 0.19, and sleep variables as mediating variables (Z). Age, sex,
p ¼ 0.010), and correlated near-significantly and nega- and SES were included as covariates. As previously
tively for weekday mornings (r ¼ 0.14, p ¼ 0.060). discussed (Rucker et al., 2011), an absence of total or

TABLE 3. Partial correlations between sleep, cognitive functioning, and behavioral problems.
Sleep duration Sleep duration Feeling rested Feeling rested Sleep stability
Behavioral problem weekdays weekend weekdays weekend MSP
Baseline speed
RT 0.07 0.04 0.14 0.19* 0.02
Sustained attention
RT 0.06 0.05 0.18* 0.11 0.04
Stability RT 0.01 0.09 0.19** 0.13 0.02
Error % sustained attention 0.10 0.09 0.12 0.14 0.02
Omissions 0.04 0.02 0.04 0.07 0.03
Feedback responsiveness 0.02 0.02 0.06 0.06 0.02
Focused attention
RT part 1 0.00 0.02 0.01 0.01 0.01
Error % part 1 0.06 0.02 0.10 0.02 0.07
RT part 2 0.03 0.03 0.10 0.03 0.03
Error % part 2 0.12 0.14 0.02 0.07 0.03
Working memorya
RT 0.05 0.03 0.15* 0.04 0.03
Error % 0.18** 0.16* 0.09 0.09 0.11
Intellectual ability
Verbal intellectual ability 0.23** 0.07 0.03 0.07 0.09
Nonverbal intellectual ability 0.14* 0.07 0.04 0.01 0.05
Behavioral problems
Total 0.05 0.02 0.24** 0.20** 0.05
Internalizing 0.09 0.02 0.19** 0.16* 0.02
Externalizing 0.04 0.04 0.19** 0.18** 0.06
Attention problems 0.02 0.03 0.17* 0.11 0.04
a
Focused Attention 4 Letters: part 2 minus part 1.
*p50.05; **p50.01.

Chronobiology International
 Eveningness, Sleep, and Problem Behavior in Children 925

direct effects does not exclude the possibility of an
indirect (mediated) effect, for instance, when one or
more direct effects oppose the indirect (mediation)
effects as a suppressor. Overall models showed that the
effect of eveningness on the total behavioral problems
score was mediated through all sleep variables together
(95% bias-corrected and -accelerated [BCA] bootstrap
confidence interval [CI] ¼ 0.0169, 0.2827) (Table 4).
Similarly, mediation through sleep was significant for
attention problems (95% BCA bootstrap CI ¼ 0.0044,
0.0625), but not for internalizing or externalizing behav-
ioral problems. Further analyses were performed to
investigate which of the sleep variables mediated the
effect of eveningness on the total behavioral problems
score and attention problems score. For both dependent
variables, there was mediation only through feeling
rested upon waking up during weekdays (total behav-
Chronobiol Int Downloaded from informahealthcare.com by Leids University on 11/04/14
Sleep as Mediator Between Eveningness
and Cognitive Functioning
Overall models of the effect of eveningness on cognitive
performance, including all sleep variables, and correct-
ing for age, sex, and SES, showed that sleep mediated
sustained attention RT (95% BCA bootstrap CI ¼ 0.0013,
0.0925), and working memory RT (95% BCA bootstrap
CI ¼ 0.4178, 4.7428) (Table 5), although the total effects
were not significant. Further analyses showed that
feeling rested upon waking up during weekdays acted
as a mediator (sustained attention RT: 95% BCA boot-
strap CI ¼ 0.0002, 0.0195; working memory RT: 95% BCA
bootstrap CI ¼ 0.0486, 3.0876).
DISCUSSION
The aim of this study was to investigate which aspects of

ioral problems: 95% BCA bootstrap CI ¼ 0.0484, 0.2490; cognition and behavioral problems are associated with
attention problems: 95% BCA bootstrap CI ¼ 0.0057, eveningness, and if sleep quantity and sleep quality are
0.0484). involved in these potential associations. The results of
the present study confirm previous findings that
TABLE 4. Eveningness and behavioral problems: direct effects and indirect mediation through sleep variables.
Behavioral problem Sleep variables b 95% CI t p
Total behavioral problems Sleep quantity and quality# Total 0.35 2.78 0.006**
Direct 0.21 1.58 0.115
For personal use only.

Indirect 0.14 0.0169, 0.2827

Rested upon awakening weekdays Total 0.35 2.84 0.005**
Direct 0.22 1.73 0.084
Indirect 0.13 0.0484, 0.2490
#
Attention problems Sleep quantity and quality Total 0.06 2.04 0.042*
Direct 0.03 0.98 0.327
Indirect 0.02 0.0044, 0.0625
Rested upon awakening weekdays Total 0.07 2.36 0.019*
Direct 0.04 1.45 0.147
Indirect 0.02 0.0057, 0.0484

#Sleep quantity and quality: sleep duration weekdays, sleep duration weekends, feeling rested upon awakening weekdays, feeling rested
upon awakening weekends, and sleep stability.
*p50.05; **p50.01.

TABLE 5. Eveningness and cognitive performance: direct effects and indirect mediation through sleep variables.
Cognitive performance Sleep variable b 95% CI t p

Sustained attention RT Sleep quantity and quality# Total 0.05 1.22 0.225
Direct 0.01 0.12 0.906
Indirect 0.05 0.0013, 0.0925
Rested upon awakening weekdays Total 0.02 1.38 0.168
Direct 0.01 0.66 0.507
Indirect 0.01 0.0002, 0.0195
Working memory RT Sleep quantity and quality# Total 3.4 1.34 0.182
Direct 1.4 0.51 0.613
Indirect 2.0 0.4178, 4.7428
Rested upon awakening weekdays Total 3.2 1.28 0.202
Direct 1.9 0.73 0.467
Indirect 1.3 0.0486, 3.0876

RT ¼ reaction time.
#Sleep quantity and quality: sleep duration weekdays, sleep duration weekends, feeling rested upon awakening weekdays, feeling rested
upon awakening weekends, and sleep stability.
*p50.05; **p50.01.

! Informa Healthcare USA, Inc.

 926 K. B. van der Heijden et al.
eveningness predicts behavioral problems in children
(Gau et al., 2007; Giannotti et al., 2002; Goldstein et al.,
2007; Lange & Randler, 2011; Paavonen et al., 2009),
although it needs to be emphasized that most behav-
ioral scores remained within the normal range and
effect sizes were rather small.
As for the relation between eveningness and cognitive
functioning, we found a significant positive association
only with verbal intellectual ability, but not for non-
verbal intellectual ability, simple reaction time, working
memory, sustained attention, and focused attention,
which contradicts our initial hypotheses. How this
might be explained will be discussed below.
Eveningness and Sleep
An individual’s circadian preference can influence
three different, but related, aspects of sleep: quantity,
Chronobiol Int Downloaded from informahealthcare.com by Leids University on 11/04/14
quality, and circadian timing. Our study has corrobo-
rated this threefold association in elementary school-
aged children. Firstly, childhood eveningness was
related to a delay in midsleep point, which is the
most reliable (subjective) measure of circadian phase
(or timing) derived from sleep assessment. Secondly,
both sleep quantity (sleep duration) and quality
(feeling rested upon awakening) were related to
eveningness. Those associations were only significant
For personal use only.
for weekdays and not for weekends, irrespective of the
fact that mean sleep duration on weekdays was similar
to that in weekends. A likely explanation is that in
evening types, sleep duration on weekdays is limited by
school start times, whereas during weekends the time
of awakening is not restricted by school schedules,
which implies that weekend sleep duration depends on
many other heterogeneous factors (e.g., parenting
factors, sleep-wake rhythm of family members,
planned social activities).
We did not categorize children into evening or
morning chronotypes, since reliable classification cri-
teria—at least for the Dutch child population—are not
available. However, previous studies showed that during
weekdays, evening-type adolescents sleep roughly half
an hour less per night than morning types (Collado
Mateo et al., 2012; Russo et al., 2007), which might result
into a chronic sleep debt in the long term.
The current results also demonstrate that evening-
ness associates with an unrested feeling upon waking up
during weekdays. Gaina et al. (2006) found similar
associations in adolescents aged 12 to 15 yrs, with
morning types reporting feeling better in the morning.
An explanation for this might be that during weekdays,
evening types need to wake up earlier than their
circadian system prefers, because they need to leave
for school. The presence of such a circadian misalign-
ment corresponds to our finding that the phase
angle between midsleep point and rising time during
weekdays is shorter for evening types than for morning
types.
Sleep Duration
Sleep duration during weekdays correlated with verbal
and nonverbal intellectual ability, in the sense that
longer sleep duration was predictive of lower cognitive
functioning. This effect was not in the expected direc-
tion, since we assumed that longer sleep duration would
predict increased cognitive functioning (Astill et al.,
2012). Furthermore, we expected longer sleep length to
be associated with increased performance on higher-
order cognitive functions such as working memory and
focused attention, but longer sleep duration was
associated with more errors on the working memory
task. Multiple explanations can be proposed: (1) In the
present study, sleep duration is not experimentally
manipulated; hence, the variation in sleep duration
stems from interindividual differences in naturalistic
sleep characteristics, which might result from a myriad
of factors such as inappropriate bedtimes, school start
times, extreme eveningness, and sleep problems, but
also from differences in sleep need, which obviously do
not indicate a deficiency in sleep quantity. (2) The
present study includes children of families with a
relatively high socioeconomic status, who are likely to
be less sensitive to the effect of sleep curtailment on
cognitive performance, possibly because they are less
likely to be exposed to other stressors in their environ-
ment than children from lower-socioeconomic-status
families. The added stress of sleep disruptions may thus
have a greater impact on children living under higher
stress conditions (Buckhalt et al., 2009).
Nevertheless, the results are in line with a recent
study by Geiger et al. (2010), which revealed a negative
association between sleep duration and IQ score in
children aged 7 to 11 yrs. The authors proposed that
these unexpected results may be explained by the neural
efficiency theory (Haier et al., 1988). They expanded this
theory to nighttime behavior, with children having a
higher daytime (cognitive) efficiency being more effi-
cient during nighttime as well, resulting in a reduced
need for sleep and therefore a shorter sleep duration.
Another explanation proposed by Geiger et al. (2010) is
that children who sleep less benefit from the longer time
awake, which facilitates more time for cognitive stimu-
lation. However, if these explanations hold, one would
also expect to find associations between sleep duration
during the weekend, which corresponds more to the
intrinsic sleep need, and intellectual ability, which was
not the case in this study.
Another possible explanation could be that there
were only few children who had a substantially short
sleep duration (17 cases with less than 9 h; 2 cases with
less than 8 h). The fact that sleep shortage was only mild
in this sample might have reduced the effect sizes.
Furthermore, although the data do not suggest that
there were excessive sleepers among the participants—
for instance, there was only one case with a sleep
duration longer than 11 h—we cannot rule out the
possibility that there were individuals who suffered from
Chronobiology International

hypersomnia. Research has shown that such individuals
with an excessive need for sleep are characterized by
poorer performance in processing speed and working
memory (Calhoun et al., 2012).
Interestingly, our finding that sleep duration does not
predict sustained attention is in line with recent meta-
analytic results, and can be explained by findings that
brain networks that are essential in top-down atten-
tional control—particularly the longer range connec-
tions along the anterior to posterior axis—start to
develop not until the final elementary school years and
therefore only minimally profit from sleep (Astill et al.,
2012). Contrary to expectations, behavioral problems
were not predicted by measures of sleep duration. This
contradicts recent meta-analytic findings (Astill et al.,
2012), but the same methodological explanations can be
proposed as described above for findings within the
Chronobiol Int Downloaded from informahealthcare.com by Leids University on 11/04/14
cognitive domain. Another explanation might be that
parents may be unaware of behavioral problems, since
problem behavior is sometimes more apparent within
the context of school. This corresponds to findings by
Aronen et al. (2000), who found associations between
sleep duration and teacher-reported behavioral prob-
lems, but not between sleep duration and parent-
reported problem behavior.
Intriguingly, the subjective sleep quality index ‘‘feel-
For personal use only.
ing more rested upon waking up’’—particularly during
weekdays—showed association with many cognitive
and behavioral measures: faster simple reaction time
and sustained attention reaction time, more sustained
attention stability, faster working memory reaction time,
and fewer behavioral problems. This suggests that the
subjective experience of not feeling rested upon awa-
kening is a much better predictor of daytime problems
than sleep quantity. This corresponds to previous
findings that subjective sleepiness is strongly associated
with cognitive performance in children (Anderson et al.,
2009; Sadeh et al., 2002).
Mediation
A central question in this study was: How is sleep
involved in the association between eveningness on the
one hand, and cognitive and behavioral functioning on
the other? The main finding is that evening types show
increased risk for behavioral problems, and that this can
be explained by the fact that they wake up feeling
unrested during weekdays. For these individuals, the
small phase angle between midsleep point and waking
time indicates that they wake up earlier on weekdays
than preferred given their circadian rhythm. That might
cause them to wake up without a rested feeling,
resulting in decreased functioning particularly during
morning hours, but possibly also during the rest of the
day. Furthermore, by means of electroencephalography
(EEG), differences have been found between morning
and evening types in markers of homeostatic sleep
regulation. The decrease in sleep pressure during sleep
in evening-type persons takes place more slowly than in
! Informa Healthcare USA, Inc.
Eveningness, Sleep, and Problem Behavior in Children 927
morning-type persons (Mongrain et al., 2006).
Therefore, in spite of similarities in sleep duration,
evening types wake with more sleep pressure remaining.
This explanation is in line with our finding that sleep
duration itself did not mediate the association between
eveningness and behavior. Thus, it seems that evening
types show behavioral problems because they wake up
before the circadian pacemaker exerts its activating
action on the arousal system and before homeostatic
sleep pressure has sufficiently reduced.
Are there any other factors besides sleep that might
explain the association between eveningness and
increased behavioral problems? Although not investi-
gated in this study, there is good reason to suggest that
aspects of personality and temperament play a role.
Evening-type persons are identified as being more
extrovert, impulsive, and novelty and sensation seeking
(Randler, 2008; Randler & Saliger, 2011; Tonetti et al.,
2010), and those traits are strongly related to externaliz-
ing behavioral problems. Furthermore, it is of note that
attention-deficit/hyperactivity disorder (ADHD)—
although moderately present in the current sample
(1%)—is strongly related to eveningness, sleep disturb-
ances, as well as cognitive/behavioral problems (Caci
et al., 2009), which might have influenced the findings.
A third alternative explanation for the association
between eveningness and behavioral problems might be
that parents of evening-oriented children are biased in
their report of behavioral problems. Eveningness in
children is likely to be accompanied with bedtime
struggles in the evening and moodiness in the morning.
This might bias parents in rating their child’s behavior,
and might therefore represent an underlying mechan-
ism in the relation between eveningness and behavior.
Nevertheless, associations between eveningness and
behavioral problems have also been found in adoles-
cents using self-report questionnaires (Gau et al., 2007).
Limitations
Several limitations of this study should be noted. First,
sleep data were derived via sleep logs and question-
naires filled in by parents, and not through objective
actigraphy or polysomnography. Secondly, circadian
markers were based on sleep-wake rhythm (midsleep
point). Dim light melatonin onset or temperature curves
are more accurate markers to evaluate whether the
circadian pacemaker in evening types was delayed
indeed. Thirdly, the CCTQ has not been validated for
the Dutch population, and Dutch normative data are
unavailable, although the current results showed suf-
ficient internal consistency, and adequate external
validity with respect to sleep-wake rhythm.
Implications
To summarize, this study in children corroborates
previous important findings in adolescents that even-
ingness is related to increased behavioral problems.
This study builds upon those findings by testing a
 928 K. B. van der Heijden et al.
theoretical framework that might explain the underlying
mechanisms. Contrary to our initial expectations, sleep
duration was hardly involved in any of the effects on
behavioral problems or cognition, although we found
compelling evidence that—also in children—evening-
ness compromises sleep duration during weekdays.
Several methodological explanations for these findings
were discussed. The most salient finding, however, is
that the subjective experience of not feeling rested upon
awakening is the key mediator of behavioral problems in
evening types. As for the underlying causes of this
subjective feeling we propose two—not mutually exclu-
sive—hypotheses that should be tested in future
research: (1) Evening types wake up before the circadian
pacemaker exerts its activating action on the arousal
system, so it is the timing of the awakening relative to
the circadian rhythm that causes them to awake with an
Chronobiol Int Downloaded from informahealthcare.com by Leids University on 11/04/14
unrested feeling. (2) Evening types wake up before the
homeostatic sleep pressure has sufficiently decreased,
which is probably not due to a shorter sleep duration
compared with morning types, but to an increased sleep
‘‘need’’ that results from a slower dissipation of sleep
pressure.
The current finding suggests that behavioral prob-
lems can result from eveningness, primarily in evening
types who report that they don’t wake up rested in the
For personal use only.
morning. Going to bed at an earlier time is not an
effective strategy; worse still, it even works counter-
productively, since the period shortly before habitual
sleep onset is characterized by the greatest drive to
wakefulness within the entire circadian period.
Bedtimes within this so-called ‘‘forbidden zone’’ can
lead to frustration about sleep and eventually impose
considerable risk of chronic sleep problems.
Entrainment of the circadian rhythm in order to estab-
lish a phase advance and, thereby, facilitate better
alignment with school times is possible, for instance,
with melatonin in the evening (e.g., Hoebert et al., 2007),
dawn simulation (wake-up light), or early-morning
bright-light therapy (Fromm et al., 2011). Of course,
instead of entraining the child’s circadian rhythm,
school times can be adjusted as well, particularly when
schools start before 8:30 h (Van der Heijden et al., 2010);
however, discussion about school times involves many
different political, economic, and social issues.
ACKNOWLEDGMENTS
The authors thank Sabine van Wijck for her assist-
ance. Furthermore, the authors are grateful to all
schools and families who participated, and to the
students of their department for collecting data.
DECLARATION OF INTEREST
The authors report no conflicts of interest. The
authors alone are responsible for the content and
writing of the paper.
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