Multimodal neuroimaging signature of sleep problems captures preadolescent mental health trajectories

Sleep-related problems (SRP) in childhood are common and clinically relevant, yet their neural correlates and links to future mental health outcomes remain poorly understood. This study investigates how distinct dimensions of SRP relate to multimodal brain structure and function in preadolescents, and whether these neural signatures are prospectively associated with trajectories of mental health difficulties. Multivariate mapping is employed to characterize the relationship between structural and functional brain network patterns and multiple dimensions of SRP in the Adolescent Brain Cognitive Development (ABCD) cohort. We then assessed whether the significant SRP-related neural signatures were prospectively associated with developmental trajectories of internalizing and externalizing symptoms across three assessments: baseline, one-year follow-up, and two-year follow-up. The analysis identifies two significant SRP dimensions: a general sleep disturbance dimension and a hypersomnolence–parasomnia dimension. Each dimension is associated with partially distinct patterns of brain morphology and functional connectivity, consistent with differential alignment along the hierarchical organization of cortical neurodevelopment. Both dimensions, however, share common disruptions in somatosensory, attention, and default mode networks. Only the multimodal neural pattern associated with the general sleep disturbance dimension was prospectively associated with higher baseline levels and slower model-estimated reductions in internalizing and externalizing symptoms across the three assessments spanning the two-year follow-up window. These findings advance understanding of the neurobiological correlates of childhood sleep-related problems and highlight a general sleep disturbance related neural signature that may inform future studies investigating the neural correlates linking childhood sleep-related problems with mental health development.