Sleep education in primary school prevents future school refusal behavior

• Published in: Pediatrics international 2019-10, Vol.61 (10), p.1036-1042
• Main Authors: Maeda, Tsutomu, Oniki, Kentaro, Miike, Teruhisa
• Format: Article
• Language: English
• Subjects: Academic Performance - psychology; Child; Child Behavior - physiology; Child Behavior - psychology; childhood chronic fatigue syndrome; Circadian Clocks; circadian rhythm disorder; delayed sleep phase syndrome; Female; Graduates; Health Behavior; Health Education - methods; Humans; Male; Pediatrics; School attendance; School Health Services; school refusal; Sleep; Sleep - physiology; Sleep and wakefulness; Sleep deprivation; Sleep disorders; sleep education program; Sleep Wake Disorders - prevention & control; Sleep Wake Disorders - psychology; Time Factors
• ISSN: 1328-8067; 1442-200X
• DOI: 10.1111/ped.13976

Background Sleep disorders, along with extreme difficulty in awakening, are one of the main causes of school refusal. The accumulation of chronic sleep deprivation accompanied by a late‐night lifestyle is considered the basic inciting factor. Methods From 2007, we initiated a sleep education program (Min‐Iku) in Fukui, Japan, with the aim of improving pupil lifestyle and preventing future school refusal. All grade 1‐6 Miyake‐primary school (M‐PS) pupils participated in this program and gave their informed consent. The Min‐Iku included (i) implementation of a “daily life rhythm survey” by recording the sleep–wake rhythm in a table for 14 days; (ii) evaluation of the sleep table according to the classifications A–D; (iii) interviews of stage D children and their guardians; (iv) lectures on the importance of daily life rhythms for parents and teachers; and (v) 45 min classwork for all participating pupils. Results In 2007, 10% of M‐PS graduates developed school refusal behavior after entering Kaminaka junior high school (K‐JHS). The incidence of school refusal, however, decreased each year after the implementation of the Min‐Iku program and finally reached 0 by 2012. The sleep onset time of pupils improved each year, with the most common sleep time reaching 9:30 p.m. on both weekdays and holidays. With an earlier sleep time, the night‐time sleep duration was significantly extended (P < 0.001 vs 2007 data). Conclusion The Min‐Iku program for primary school pupils successfully achieved a more routine night‐time sleep pattern and a regular life rhythm, which prevented school refusal during the subsequent JHS years.