In Reply:

Letters to the Editor regarding the article Point Prevalence and Risk Factors for Insomnia in Children and Adolescents Findings of a Population-Based Survey by Magdalena Wieder, Rainer Thomasius, and Kerstin Paschke in issue 17/2025

We thank our colleagues Kowall and Stang for their critical comments and valuable pointers regarding our study of the point prevalence of and risk factors for insomnia in children (1).

The reference to the so-called “table 2 fallacy” is understandable. However, our objective was not to estimate causal effects but to test the associations between potential risk factors known from the literature and insomnia severity. The approach we selected to this end reflects current practice in psychological and epidemiological research, since common models control for overlap between predictors and prevent α-error accumulation by using multiple analyses (2, 3, 4). On the background of the existing research gap regarding insomnia in children and adolescents this approach furthermore seems particularly suitable for testing associations empirically, deduct possible models, and generate further research questions. A causal interpretation of the regression coefficients was not intended at any point in time; our results should be understood as adjusted associations.

We agree that a cross-sectional design does not allow for any conclusions regarding the temporal direction of the associations and considered this in explaining and categorizing our results. The mutual relation between parental insomnia and insomnia in children seems plausible and should be tested in future longitudinal studies.

The small case number regarding obesity reflects the low prevalence in the sample. This was listed as a limitation. To increase the conclusiveness, larger or specifically stratified samples are advisable.

DOI: 10.3238/arztebl.m2025.0179

On behalf of the authors

PD Dr. med. Dipl.-Psych. Kerstin Paschke

Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters (DZSKJ)

Universitätsklinikum Hamburg-Eppendorf

Conflict of interest statement

The authors declare that no conflict of interest exists.

References

1. Wieder M, Thomasius R, Paschke K: Point prevalence and risk factors for insomnia in children and adolescents: Findings of a population-based survey. Dtsch Arztebl Int 2025; 122: 461–6.

2. Gelman A, Hill J, Vehtari A: Regression and other stories. Cambridge University Press, 2020.

3. Cohen J, Cohen P, West SG, Aiken LS: Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences (3rd ed.). Routledge, 2013.

4. Tabachnick BG, Fidell LS: Using Multivariate Statistics. 7th ed. Pearson, 2019.