Sleep and Internalizing Problems as Mediators of Medical Service Usage Among Youth with and without Conduct Problems.

Childhood conduct problems are associated with high medical service use in adolescence, though the mechanisms are unclear. The current study examined whether sleep and internalizing problems mediate the association between childhood conduct problems and adolescent medical service usage. Participants were drawn from a longitudinal study (N = 744; 53% boys) evaluating the development of conduct problems among girls and boys (6.3-9.9 years at baseline; Mage = 8.43). Conduct problems, sleep, and internalizing problems were assessed by parents, teachers, and youth. Service use data was collected from public medical records. Significant indirect effects between childhood conduct problems and medical service usage via parent-reported sleep and internalizing problems were observed. Histories of conduct problems were associated with higher levels of sleep and internalizing difficulties which were subsequently linked to higher service usage. Findings support the importance of addressing sleep and internalizing problems in mitigating future health consequences for youth with conduct problems.