Co‐sleeping: Help or hindrance for young children's independence?

This study investigated the relationship between sleep arrangements and claims regarding possible problems and benefits related to co‐sleeping. Participants were 83 mothers of preschool‐aged children. Data were collected through parent questionnaires. Early co‐sleepers (who began co‐sleeping in infancy), reactive co‐sleepers (children who began co‐sleeping at or after age one), and solitary sleepers were compared on the dimensions of maternal attitudes toward sleep arrangements; night wakings and bedtime struggles; children's self‐reliance and independence in social and sleep‐related behaviours; and maternal autonomy support. The hypothesis that co‐sleeping would interfere with children's independence was partially supported: solitary sleepers fell asleep alone, slept through the night, and weaned earlier than the co‐sleepers. However, early co‐sleeping children were more self‐reliant (e.g. ability to dress oneself) and exhibited more social independence (e.g. make friends by oneself). Mothers of early co‐sleeping children were least favourable toward solitary sleep arrangements and most supportive of their child's autonomy, as compared to mothers in other sleep groups. Reactive co‐sleepers emerged as a distinct co‐sleeping sub‐type, with parents reporting frequent night wakings and, contrary to early co‐sleepers, experiencing these night wakings as highly disruptive. Implications for parents and pediatricians are discussed. Copyright © 2004 John Wiley & Sons, Ltd.     

The behavioural treatment of sleep difficulties in children with an intellectual disability

Reinforcement, instruction giving, partner support strategies, bedtime routine, and standard extinction were taught to the parents of three boys (aged 5–10 years) with an intellectual disability and sleeping difficulties. Sleep was measured using sleep diaries and actigraphy, and daytime behaviour was monitored using diaries and direct observation. At referral, all children needed a parent present to fall asleep, two had co‐sleeping difficulties, and two had night waking difficulties. At post‐intervention, all children were falling asleep independently, co‐sleeping was eliminated for two children, and night waking was reduced in one child. An extinction burst was experienced by two children, with one family putting their child back to bed 259 times on the first night. Though one child still had night waking difficulties following intervention, actigraph recording demonstrated an improvement in his sleep quality. In addition to the children's independence, improvements were seen for sleep length, sleep latency, and morning wake time. However, improvements in daytime behaviour showed inconsistency across behaviours and settings. Improvement in sleep was maintained at a three month follow‐up. It was concluded that using extinction to address sleep problems in children with an intellectual disability is effective and approved of by parents, but any impact on daytime behaviour is equivocal. Copyright © 2002 John Wiley & Sons, Ltd.     

The evidence base for family therapy and systemic interventions for child‐focused problems

This review updates similar articles published in the Journal of Family Therapy in 2001 and 2009. It presents evidence from meta‐analyses, systematic literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with various difficulties. In this context, systemic interventions include both family therapy and other family‐based approaches such as parent training. The evidence supports the effectiveness of systemic interventions either alone or as part of multi‐modal programmes for sleep, feeding and attachment problems in infancy; child abuse and neglect; conduct problems (including childhood behavioural difficulties, attention deficit hyperactivity disorder, delinquency and drug misuse); emotional problems (including anxiety, depression, grief, bipolar disorder and self‐harm); eating disorders (including anorexia, bulimia and obesity); somatic problems (including enuresis, encopresis, medically unexplained symptoms and poorly controlled asthma and diabetes) and first episode psychosis.     

Family therapy and systemic interventions for child‐focused problems: the current evidence base

This review updates previous similar papers published in JFT in 2000, 2009 and 2014. It presents evidence from meta‐analyses, systematic literature reviews, narrative literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with common mental health problems and other difficulties. In this context, systemic interventions include both family therapy and other family‐based approaches such as parent training, or parent implemented behavioural programmes. The evidence supports the effectiveness of systemic interventions either alone or as part of multimodal programmes for sleep, feeding and attachment problems in infancy; recovery from child abuse and neglect; conduct problems, emotional problems, eating disorders, somatic problems, and first episode psychosis.     

Parent‐selected interventions for infants at‐risk for autism spectrum disorders and their affected siblings

Infants with older siblings having Autism Spectrum Disorders (ASD) are at genetically increased risk for showing characteristics of ASD in the first 2 years of life. Parents, who already have at least one child with ASD, may closely monitor their later born children and implement interventions as soon as the children begin to show what the parents believe is aberrant behavior or development that may be early stages of ASD. To date, no study has examined the number and types of services and interventions these parents access for their at‐risk infants. Using a Service and Intervention Questionnaire developed for this study, we interviewed 23 parents involved in a larger prospective study of genetically at‐risk infants who reported developmental and/or behavior problems in their at‐risk infants. Parents reported utilizing a mean of 1.83 and 7.26 services and/or interventions for their at‐risk infants and older children with ASD, respectively. Two‐thirds of the interventions received by the infants were also given to their older affected siblings. The interventions included empirically validated approaches (e.g., early intensive behavioral intervention), professional services (speech–language therapy, occupational therapy), and non‐validated treatments (e.g., diet and vitamin therapies). Overall, 81 non‐validated and 18 validated interventions were used. On a Likert‐type rating scale, parents reported being involved and satisfied with what they generally thought were effective services. They felt more involved and satisfied with ABA, and felt it was more effective than non‐validated interventions. The findings suggest that parents with infants at‐risk for ASD and an older affected child will access a variety of autism services for both children, but the parents will implement primarily non‐validated interventions. Parent education is recommended to help parents make informed treatment decisions for their children. Copyright © 2009 John Wiley & Sons, Ltd.     

Using Community Partnerships to Better Understand the Barriers to Using an Evidence‐Based,Parent‐Mediated Intervention for Autism Spectrum Disorder in a Medicaid System

Service use disparities have been noted to impede under‐resourced families' ability to access high‐quality services for their child with autism spectrum disorder (ASD). These disparities are particularly relevant for parent‐mediated interventions and may suggest a lack of fit between these interventions and the needs of under‐resourced community settings. This study used Roger's Diffusion of Innovations theory to guide community partnerships aimed at understanding the perceived compatibility, complexity, and relative advantage of using an evidence‐based, parent‐mediated intervention (Project ImPACT) within a Medicaid system. Three focus groups were conducted with 16 Medicaid‐eligible parents, and three focus groups were conducted with 16 ASD providers operating within a Medicaid system. Across all groups, parents and providers reported general interest in using Project ImPACT. However, primary themes emerged regarding the need to (a) reduce the complexity of written materials; (b) allow for a more flexible program delivery; (c) ensure a strong parent–therapist alliance; (d) involve the extended family; and (e) help families practice the intervention within their preexisting routines. Results are discussed as they relate to the design and fit of evidence‐based, parent‐mediated interventions for under‐resourced community settings.     

Parent–infant co‐sleeping: fathers' roles and perspectives

Dyadic co‐sleeping (mother–baby) is a common strategy for night‐time infant care in the majority of world cultures. Triadic co‐sleeping (mother–father–baby) is less common, although still widely practised cross‐culturally. This paper examines triadic co‐sleeping in an opportunistic sample of parents from the North Tees region of England, and explores fathers' expectations and experiences of sleeping with their babies. Using a prospective study design, 36 sets of parents, pre‐ and post‐natally, were interviewed about infant care strategies, particularly at night. Although they did not anticipate sleeping with their infants at the pre‐natal interview, the majority of fathers (81%) had done so by the time of the second interview. First‐time fathers were afraid that they would squash or suffocate the baby in their sleep, and some were concerned that the infant's presence would adversely affect their own sleep. Fathers used a variety of strategies to help overcome their initial fears of co‐sleeping. Among those for whom triadic co‐sleeping became a regular night‐time infant care strategy, the pleasures of prolonged intimate contact with their infant were clearly apparent. It is suggested that the experience of sleeping with their infant ameliorates some of the distancing effects felt by fathers outside the breast‐feeding relationship, and helps encourage paternal involvement in night‐time infant care‐giving. Copyright © 2000 John Wiley & Sons, Ltd.     

Atypicalities in sleep and semantic consolidation in autism

Sleep is known to support the neocortical consolidation of declarative memory, including the acquisition of new language. Autism spectrum disorder (ASD) is often characterized by both sleep and language learning difficulties, but few studies have explored a potential connection between the two. Here, 54 children with and without ASD (matched on age, nonverbal ability and vocabulary) were taught nine rare animal names (e.g., pipa). Memory was assessed via definitions, naming and speeded semantic decision tasks immediately after learning (pre‐sleep), the next day (post‐sleep, with a night of polysomnography between pre‐ and post‐sleep tests) and roughly 1 month later (follow‐up). Both groups showed comparable performance at pre‐test and similar levels of overnight change on all tasks; but at follow‐up children with ASD showed significantly greater forgetting of the unique features of the new animals (e.g., pipa is a flat frog). Children with ASD had significantly lower central non‐rapid eye movement (NREM) sigma power. Associations between spindle properties and overnight changes in speeded semantic decisions differed by group. For the TD group, spindle duration predicted overnight changes in responses to novel animals but not familiar animals, reinforcing a role for sleep in the stabilization of new semantic knowledge. For the ASD group, sigma power and spindle duration were associated with improvements in responses to novel and particularly familiar animals, perhaps reflecting more general sleep‐associated improvements in task performance. Plausibly, microstructural sleep atypicalities in children with ASD and differences in how information is prioritized for consolidation may lead to cumulative consolidation difficulties, compromising the quality of newly formed semantic representations in long‐term memory.     

“Ghosts in the Nursery:” Infant sleep and sleep‐related cognitions of parents raised under communal sleeping arrangements

In an experiment of nature, a normal cohort of parents who were raised under communal sleeping arrangements (CSA) in Israeli kibbutzim are raising their infants at home under home‐based family sleeping arrangements. The present study focused on exploring the links between the early sleep experiences of CSA parents and their present sleep‐related beliefs and behaviors. In particular, the study assessed whether the cognitions of CSA parents regarding infant sleep differ from cognitions of parents who were raised under home‐based family sleeping arrangements. Furthermore, parental soothing methods and infant sleep patterns were compared. One hundred forty‐one families participated in this study. The children's ages ranged between 4.5 to 30 months. Parental cognitions were evaluated by two questionnaires. Infant sleep was assessed by a questionnaire and by daily parental reports. As expected, CSA parents were more likely than were control parents to: (a) interpret infant night wakings as a sign of distress and (b) actively soothe their infants at bedtime, co‐sleep with them, and report more night wakings of their infants. These findings support the hypothesis that early childhood sleep‐related experiences of parents (“Ghosts in the Nursery”) influence their parental sleep‐related cognitions that in turn affect infant sleep patterns.     

Sleep problems,anxiety and cognitive style in school‐aged children

The associations between sleep problems, anxiety, anxiety sensitivity and attributional style were examined in self‐report data from 79 children aged 8–11 years. Total anxiety score was associated with different types of sleep problems (bedtime resistance, sleep anxiety and nightmares). Conversely, total sleep problem score was associated with different sub‐scales of anxiety (from r(78) = 0.15, p = NS to r(79) = 0.47, p < 0.01). Symptoms of anxiety correlated significantly with anxiety sensitivity, but not with attributional style. After controlling for other symptoms of anxiety, school phobias (Beta = 0.26, p < 0.05), the mental incapacitation concerns scale of anxiety sensitivity (Beta = 0.26, p < 0.05), and attributional style (Beta = −0.31, p < 0.01, R² = 0.45) predicted sleep problems. These results suggest that anxiety is associated with a range of sleep problems, and that sleep problems are associated with different types of anxiety. Furthermore, certain cognitive styles are associated with both anxiety and sleep problems and may be good candidates for further research into the association between sleep problems and anxiety in children. Copyright © 2005 John Wiley & Sons, Ltd.     

Examination of efficacious,efficient, and socially valid error‐correction procedures to teach sight words and prepositions to children with autism spectrum disorder

Prior research shows that learners have idiosyncratic responses to error‐correction procedures during instruction. Thus, assessments that identify error‐correction strategies to include in instruction can aid practitioners in selecting individualized, efficacious, and efficient interventions. The current investigation conducted an assessment to compare 5 error‐correction procedures that have been evaluated in the extant literature and are common in instructional practice for children with autism spectrum disorder (ASD). Results showed that the assessment identified efficacious and efficient error‐correction procedures for all participants, and 1 procedure was efficient for 4 of the 5 participants. To examine the social validity of error‐correction procedures, participants selected among efficacious and efficient interventions in a concurrent‐chains assessment. We discuss the results in relation to prior research on error‐correction procedures and current instructional practices for learners with ASD.     

Consistency in infant sleeping arrangements and mother–infant interaction

This study examined the association between infant sleeping arrangements (i.e., habitual co‐sleeping, inconsistent co‐sleeping, and non‐co‐sleeping) and quality of mother–infant interaction during play in a sample of mothers, each with a typically developing infant (N=70). Mother–infant dyads who experienced consistency in infant sleeping arrangements in a typical week at 6 months (i.e., habitual co‐sleeping or non‐co‐sleeping) were characterized by more positive maternal and infant behavior and dyadic quality of interaction at 9 months compared with dyads who experienced inconsistency in sleeping arrangements. Additionally, a greater amount of co‐sleeping per week was associated with an increased duration of breastfeeding, mothers working fewer hours, less infant temperamental intensity, and less maternal depression. This study underscores the advantages of empirically based studies that consider consistency in infant sleep experience as a factor that is associated with more positive mother–child interaction.     

A blueprint for general‐case procedures illustrated by teaching adolescents with autism spectrum disorder to use a chip‐debit card

Individuals diagnosed with autism spectrum disorder (ASD) often respond poorly to novel stimulus combinations and may have difficulty discriminating across critical and noncritical stimulus dimensions without direct teaching. General‐case procedures and multiple‐exemplar training have been effectively used to address this deficit. In the current study, the experimenters outlined general‐case procedures with video modeling, prompting and reinforcement to teach three adolescents with ASD a generalized repertoire of using a chip‐debit card. A multiple‐probe across participants design demonstrated the effectiveness of these procedures. All participants acquired the skill, responding generalized from simulated teaching materials to four novel automatic payment machines, and maintained 4 weeks following teaching. Implications of using these general‐case procedures as a blueprint for future researchers to reference when teaching individuals with ASD a generalized repertoire of any skill are discussed.     

The role of attachment security,temperament, maternal perception,and care‐giving behavior in persistent infant sleeping problems

This study investigates the relationship of etiological factors to infant sleeping problems during the first year, and at follow‐up during the second year of life. The relevant factors for concurrent sleeping problems (in order of importance) were problematic maternal cognition concerning setting limits on the infant, fussy–difficult infant temperament, maternal anxiety–depression, ambivalent attachment, and certain maternal care‐giving behaviors involving the use of active physical comforting (cuddling to sleep, settling on sofa or in parental bed, and giving a feed). High initial levels of sleeping problems largely explained the continuity in infant sleeping problems over time. However, this continuity was significantly mediated by the influence of both problematic maternal cognition and infant temperament on the parental use of active physical comforting to settle infants to sleep. In addition, ambivalent attachment had a small but significant independent contribution to persistent problems. Regarding discontinuity in infant sleeping problems over time, infants who developed sleeping problems were those whose parents used high levels of active physical comforting, whereas those infants whose sleeping problems recovered were more likely to have mothers with low depression–anxiety. The significance of these results is discussed with respect to developmental models of infant sleeping problems, and the assessment and treatment of infant sleeping problems. ©2003 Michigan Association for Infant Mental Health.     

Should you Sleep on it? The Effects of Overnight Sleep on Subjective Preference‐based Choice

Conventional wisdom and studies of unconscious processing suggest that sleeping on a choice may improve decision making. Although sleep has been shown to benefit several cognitive tasks, including problem solving, its impact on everyday choices remains unclear. Here we explore the effects of ‘sleeping on it’ on preference‐based decisions among multiple options. In two studies, individuals viewed several attributes describing a set of items and were asked to select their preferred item after a 12‐hour interval that either contained sleep or was spent fully awake. After an overnight period including sleep, individuals showed increases in positive perceptions of the choice set. This finding contrasts with previous research showing that sleep selectively enhances recall for negative information. In addition, this increase in positive recall did not translate into a greater desire to purchase their preferred item or into an overall benefit for choice satisfaction. Time‐of‐day controls were used to confirm that the observed effects could not be explained by circadian influences. Thus, we show that people may feel more positive about the choice options but not more confident about the choice after ‘sleeping on’ a subjective decision. We discuss how the valence of recalled choice set information may be important in understanding the effects of sleep on multi‐attribute decision making and suggest several avenues for future research. Copyright © 2015 John Wiley & Sons, Ltd.     

A Review of Pediatric Nonpharmacological Sleep Interventions: Effects on Sleep,Secondary Outcomes,and Populations With Co-occurring Mental Health Conditions

Sleep problems are common in school-age children and linked to numerous negative outcomes. Sleep disturbances are particularly common in children with mental health disorders, such as attention-deficit/hyperactivity disorder, depression, and anxiety. Despite frequent use of nonpharmacological pediatric sleep interventions to treat common sleep problems, there is a paucity of research on whether these interventions are effective. Further, it is unclear whether by targeting sleep, these interventions lead to broader improvements in the domains of functioning that are commonly affected by poor sleep. The present review includes 20 studies that evaluated nonpharmacological sleep treatments for school-aged youth, including 5 studies specifically focused on youth with externalizing or internalizing problems. Multimodal approaches consisting of psychoeducation and sleep hygiene in combination with other components were effective at treating insomnia and general sleep problems in typically developing samples. The addition of behavioral parent training to sleep interventions was effective for youth with externalizing problems, whereas incorporating cognitive strategies into sleep interventions for youth with internalizing problems was found to be ineffective. A variety of secondary outcomes were examined, with the strongest support emerging for improvement in anxiety and behavioral problems. Implications for clinical practice and future research directions are discussed.     

Teaching conversational speech to children with autism spectrum disorder using text‐message prompting

The present study was designed to teach conversational speech using text‐message prompts to children with autism spectrum disorder (ASD) in home play settings with siblings and peers. A multiple baseline design across children was used. Children learned conversational speech through the text‐message prompts, and the behavior generalized across peers and settings. Maintenance of treatment gains was seen at 1‐month follow‐up probes. Social validity measures indicated that parents of typically developing children viewed the participants' conversational speech as much improved after the intervention. Results are discussed in terms of the efficacy of text‐message prompts as a promising way to improve conversational speech for children with ASD.     

Visual search and autism symptoms: What young children search for and co‐occurring ADHD matter

Superior visual search is one of the most common findings in the autism spectrum disorder (ASD) literature. Here, we ascertain how generalizable these findings are across task and participant characteristics, in light of recent replication failures. We tested 106 3‐year‐old children at familial risk for ASD, a sample that presents high ASD and ADHD symptoms, and 25 control participants, in three multi‐target search conditions: easy exemplar search (look for cats amongst artefacts), difficult exemplar search (look for dogs amongst chairs/tables perceptually similar to dogs), and categorical search (look for animals amongst artefacts). Performance was related to dimensional measures of ASD and ADHD, in agreement with current research domain criteria (RDoC). We found that ASD symptom severity did not associate with enhanced performance in search, but did associate with poorer categorical search in particular, consistent with literature describing impairments in categorical knowledge in ASD. Furthermore, ASD and ADHD symptoms were both associated with more disorganized search paths across all conditions. Thus, ASD traits do not always convey an advantage in visual search; on the contrary, ASD traits may be associated with difficulties in search depending upon the nature of the stimuli (e.g., exemplar vs. categorical search) and the presence of co‐occurring symptoms.     

A model for predicting behavioural sleep problems in a random sample of Australian pre‐schoolers

Behavioural sleep problems (childhood insomnias) can cause distress for both parents and children. This paper reports a model describing predictors of high sleep problem scores in a representative population‐based random sample survey of non‐Aboriginal singleton children born in 1995 and 1996 (1085 girls and 1129 boys) in Western Australia. Longitudinal repeated data were collected up to age 4 years by caregiver report. Children's sleep rhythmicity levels in their first year, as well as conflicted and lax parenting in their second year, predicted higher scores on the sleep problem scale from the Child Behaviour Checklist/2–3 in the children's third year. Higher scores on the sleep problem scale in the children's third year predicted higher scores on the aggressive behaviour subscale of the Child Behaviour Checklist/4–16. The results support a model in which sleep problems mediated the relationship between parental conflict and aggressive behaviour, even when controlling for maternal depression, which has been associated with children's aggressive behaviour. Copyright © 2007 John Wiley & Sons, Ltd.