Objective: Pediatric neuropsychologists, psychiatrists, and other mental health professionals routinely contend with difficult behaviors in the children they evaluate. One hypothesized factor contributing to difficult in-session behavior is lack of sleep. We tested this hypothesis by correlating in-session examiner ratings of difficult child behaviors—during the evaluation process—with average nightly sleep. Method: Forty-two youths (ages 4 through 18 years) referred for outpatient clinical neuropsychological evaluations had their in-session behavior rated during the evaluation using the Test Observation Form (TOF), yielding T-scores across 11 overlapping domains of in-session behavior: withdrawn/depressed; language/thought problems; anxious; oppositional; attention problems; internalizing problems; externalizing problems; attention-deficit/hyperactivity problems; inattention; hyperactivity/impulsive; and total problems. Scores were then correlated with average number of hours of sleep, as reported by caregivers. Results: Average hours of sleep each night negatively correlated with in-session anxious behavior (r - .324; p = .036). Beyond this, however, not even slight associations between average hours of...

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