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.     

Learning to sleep through the night: Solution or strain for mothers and young children?

Is the process of helping infants and young children learn to sleep through the night a solution to family sleep problems or does it exacerbate matters for mother and child? Retrospective and current accounts from a nonclinical, convenience sample of 102 mothers of preschool‐aged children provided information on sleep issues from early infancy through preschool age. Child, mother, and parenting characteristics, along with family sleep arrangements, were differentially related to the age at which children learned to sleep through the night and to the extent of difficulty that characterized this experience. Mothers who indicated more difficulty as their children learned to sleep through the night also reported more depressive symptoms and more strain in the mother–child relationship. Later age at sleeping through the night was more common among early bedsharers, but timing of sleeping through the night was not associated with preschool children's reported independence in several nonsleep domains. Sleep arrangements and the importance placed on sleeping through the night were the strongest contributors to variance explained in whether children learned to sleep through the night during infancy or toddlerhood. When advising parents about sleep interventions, practitioners should seek to understand whether families' parenting values fit their nighttime sleep practices.     

Effectiveness of an mHealth Intervention for Infant Sleep Disturbances

Bedtime problems and night wakings are highly prevalent in infants. This study assessed the real-world effectiveness of an mHealth behavioral sleep intervention (Customized Sleep Profile; CSP). Caregivers (83.9% mothers) of 404 infants (age 6 to 11.9 m, M = 8.32 m, 51.2% male) used the CSP (free and publicly available behavioral sleep intervention delivered via smartphone application, Johnson’s® Bedtime® Baby Sleep App). Caregivers completed the Brief Infant Sleep Questionnaire–Revised (BISQ-R) at baseline and again 4 to 28 days later. Changes in sleep patterns were analyzed, based on sleep problem status (problem versus no problem sleepers; PS; NPS). Sleep onset latency improved in both groups. Earlier bedtimes, longer continuous stretches of sleep, as well as decreased number and duration of night wakings, were evident in the PS group only. The BISQ-R Total score, total nighttime sleep, and total 24-hour sleep time improved for both groups, with a greater change for the PS group. Further, caregivers of infants in the PS group decreased feeding (bedtime and overnight) and picking up overnight, and perceived better sleep. Bedtime routine regularity, bedtime difficulty, sleep onset difficulty, and caregiver confidence improved for both groups, with the PS group showing a greater magnitude of change. Thus, a real-world, publicly available, mHealth behavioral sleep intervention was associated with improved outcomes for older infants. Intervention recommendations resulted in changes in caregivers’ behavior and improvements in caregiver-reported sleep outcomes in infants, in as few as 4 days.     

Maternal beliefs concerning young children's private speech

The goal of this study was to understand maternal reports, beliefs, and attitudes about their young children's use of private speech. Mothers of 48 children between the ages of 3 and 5 participated in a semi‐structured interview in which they reported on the frequency and context of their child's use of private speech, maternal responses toward such speech use in children, and beliefs about the utility of such speech for children. Interviews were transcribed and responses coded. Mothers also completed surveys on children's self control and parenting style. Results indicated that practically all parents reported that their child engaged in private speech and that such speech was more likely to appear during fantasy play than during problem‐solving activities. Parents varied in their personal responses to children's self talk and, as a group, do not appear to actively discourage or encourage its use. Ignoring/allowing child private speech use was common and this response was positively associated with authoritative parenting. Parental reports of the frequency with which their child talks to himself were negatively associated with parental reports of children's self‐control. Crib speech, or bedtime monologue, was reported to be very common and was negatively associated with children's self‐control and positively associated with children's private speech use. Parents were uniformly positive in their belief that private speech serves important functions and that it helps young children during task activities. Copyright © 2006 John Wiley & Sons, Ltd.     

IGNORING CHILDREN'S BEDTIME CRYING: THE POWER OF WESTERN‐ORIENTED BELIEFS

Ignoring children's bedtime crying (ICBC) is an issue that polarizes parents as well as pediatricians. While most studies have focused on the effectiveness of sleep interventions, no study has yet questioned which parents use ICBC. Parents often find children's sleep difficulties to be very challenging, but factors such as the influence of Western approaches to infant care, stress, and sensitivity have not been analyzed in terms of ICBC. A sample of 586 parents completed a questionnaire to investigate the relationships between parental factors and the method of ICBC. Data were analyzed using structural equation modeling. Latent variables were used to measure parental stress (Parental Stress Scale; J.O. Berry & W.H. Jones, 1995), sensitivity (Situation‐Reaction‐Questionnaire; Y. Hänggi, K. Schweinberger, N. Gugger, & M. Perrez, 2010), Western‐oriented parental beliefs (Rigidity), and children's temperament (Parenting Stress Index; H. Tröster & R.R. Abidin). ICBC was used by 32.6% (n = 191) of parents in this study. Parents’ Western‐oriented beliefs predicted ICBC. Attitudes such as feeding a child on a time schedule and not carrying it out to prevent dependence were associated with letting the child cry to fall asleep. Low‐sensitivity parents as well as parents of children with a difficult temperament used ICBC more frequently. Path analysis shows that parental stress did not predict ICBC. The results suggest that ICBC has become part of Western childrearing tradition.     

How Do Mothers Help Their Children Sleep at Night? Night‐waking Strategy Use Among Mothers of Preschool‐aged Children

Night‐waking is common among preschool‐aged children. Little is known about night‐time parenting among parents of preschool‐aged children. To explore night‐waking strategy use in a community sample, 203 mothers (M age = 32 years, SD = 5.1; children's M age = 3.4 years, SD = 1.0) completed the Night‐waking Strategy Scale (NSS) and measures of general parenting, agreement with night‐waking strategies, and children's sleep. Children were grouped by age (2‐, 3‐, and 4‐to‐5‐year‐olds). Mothers endorsed using routines most frequently, followed by active comforting and rewards; limit‐setting and punishment were used less often. NSS punishment and routines were significantly associated with parenting (e.g. laxness was correlated with NSS routines, rs = ?.35 to .47, p < .001). Night‐waking strategy use was correlated with agreement with those strategies (e.g. active comforting was correlated with agreement with active comforting rs = .35 to .52, p < .001). Active comforting was correlated with the frequency of children's night‐waking for 2‐ and 3‐year‐olds (rs = .35 and .38, respectively, p < .01). Mothers of preschool‐aged children in the community engage in a range of parenting strategies to manage children's night‐waking. These strategies are largely consistent with general parenting and agreement with night‐waking strategy use. Copyright © 2014 John Wiley & Sons, Ltd.     

Treating sleep disturbance in infants: What generalizes?

When treating infant sleep problems implementing treatment procedures at bedtime‐only might be easier and more efficient than requiring parents to implement procedures throughout the night, but only if improvements at bedtime generalize to later in the night. This study investigated the immediate and generalized effect of treating bedtime settling problems and later night waking in infants and whether it was parent or child behavior that generalized. Parents recorded sleep problems of seven infants (6–20 months) who exhibited chronic sleep disturbance, then implemented a graduated checking procedure at bedtime‐only (Setting 1). A multiple‐baseline across‐settings and participants design was employed. Immediate (in Setting 1) and any generalized effects (in Setting 2) on wakings and other changes in parent and child behavior were assessed by diary information and all‐night infra‐red video recordings. Clinically significant reductions in sleep problems were evident for five out of seven infants, but these were not consistently observed until parents generalized their use of the procedure throughout the night. There was no evidence that the infants generalized changes in self‐soothing from bedtime to later. It is concluded that changes in infant sleep problems are unlikely to occur unless parents actually alter their management of the problems across all settings in which the problems occur. Copyright © 2008 John Wiley & Sons, Ltd.     

Early childhood co-sleeping: Parent-child and parent-infant nighttime interactions

This study investigated parent—child interactions during sleep onset and nighttime arousals in a rural sample of preschool children. The role of co-sleeping in relation to sleep habits and night waking was examined using parental self-report of both current and retrospective sleep patterns. The results showed that Solitary Sleepers engaged in more complex bedtime routines, and had more longstanding and stronger attachment to security objects and sleep aids, than did Co-sleepers. Infancy precursors to co-sleeping in early childhood were a history of breastfeeding, night feedings in the parent's bed, and returning to sleep in the parent's bed.     

Parenting and toddler self-regulation in low-income families: What does sleep have to do with it?

Toddlerhood is a sensitive period in the development of self-regulation, a set of adaptive skills that are fundamental to mental health and partly shaped by parenting. Healthy sleep is known to be critical for self-regulation; yet, the degree to which child sleep alters interactive child–parent processes remains understudied. This study examines associations between observed parenting and toddler self-regulation, with toddler sleep as a moderator of this association. Toddlers in low-income families (N = 171) and their mothers were videotaped during free play and a self-regulation challenge task; videos were coded for mothers’ behavior and affect (free play) and toddlers’ self-regulation (challenge task). Mothers reported their child's nighttime sleep duration via questionnaire. Results revealed significant Sleep × Maternal Negative Affect and Sleep × Maternal Negative Control interactions. Children who did not experience negative parenting had good self-regulation regardless of their nighttime sleep duration. For children who did experience negative parenting, self-regulation was intact among those who obtained more nighttime sleep, but significantly poorer among children who were getting less nighttime sleep. Thus, among children who were reported to obtain less nighttime sleep, there were more robust associations between negative parenting and poorer self-regulation than among toddlers who were reported to obtain more sleep.     

Severity of sleep problems in children with severe learning difficulties: Description and correlates

In this study we have examined the percentage occurrence of settling and waking problems and of sleeping in the parents' bed in a sample of children with sleep problems. We found that about two-thirds had settling problems, nearly nine-tenths had waking problems, and one-third slept regularly in their parents' bed. Parents of children with sleep problems were more likely to experience a range of family problems than were parents of children without problems, and they were more likely to report a range of symptoms of stress. Most children with settling problems took at least two hours to settle to sleep at night. This behaviour was mainly tolerated or accepted by the parents. Parents gave a variety of suggestions as to triggers for settling problems, from being upset during the day to fears, illness and alterations in routine. Most parents thought the underlying explanation was the child's intellectual impairment. Over half the children with waking problems woke up every night, while 85% woke up at least three nights a week. One-third woke up three or more times a night. About two-thirds took up to half an hour to resettle, with one-third taking up to an hour. Parents (mainly mothers) tended to get up to attend to the waking child. About half of the children were thought to need attention because of physical disabilities. Illness, alteration in routine, becoming ‘overtired’ and ‘upset’ were thought to trigger waking problems. Intellectual impairment was again seen as the more general underlying reason for waking problems. Very few children were receiving treatment for their problems—7% were receiving medication and one was receiving a behavioural programme. Few parents had a systematic bedtime routine for their child and few had a consistent agreed response to settling or waking problems. When we examined the relationship between certain family variables and severity of sleep problems a number of relationships were found. Sleep problem severity was related to maternal responsiveness, maternal stress, impact of the child on the family, maternal behaviour towards the child, maternal attitudes towards the child and marital satisfaction. Severity of sleep problems was also related to certain child characteristics. Children with more severe problems tended to present more problems in their daytime behaviour. Sleep problem severity was also found to be related to child communication skills. These findings, together with those from other pilot studies, suggest that using behavioural methods of managing sleep problems might prove a promising way forward.     

Self-control depletion and sleep duration: the mediating role of television viewing

Abstract

Objective: Sleep insufficiency has been related to self-control failure: people fail to go to bed in time and end up sleep deprived. The role of state self-control in predicting bedtime and sleep duration has not yet been investigated. Based on research claiming an overlap between depleted self-control resources and fatigue, self-control depletion may foster earlier bedtimes. Conversely, self-control depletion also increases the propensity to procrastinate bedtime by giving in to the immediate gratification of late night entertainment. This study therefore looked at procrastinatory television viewing and its intermediary role in the association between state self-control and bedtime. The implications for sleep duration are examined. Design: Firstyear students (N = 234) participated in an online survey. Using Day Reconstruction Method, they charted their activities and experiences during the preceding day and subsequent bedtime behavior. Results: Self-control depletion was directly related to earlier bedtimes, which we explained by its similarity to fatigue. This was associated with longer sleep duration. Self-control depletion was indirectly related to later bedtimes because it increased the propensity to procrastinate by watching television. This was associated with shorter sleep duration. Conclusion: This study exposes a dual pathway between self-control depletion and sleep duration, whereby procrastinatory television viewing may reduce sleep duration.     

Parental behaviour and children's creation of imaginary companions: A longitudinal study

This longitudinal study examined whether parenting quality, parental behaviours and children's temperament at 6 months of age predicted children's creations of imaginary companions (ICs) at 44 months of age. At six months, parenting quality and parental behaviours were measured using the Parent-Child Early Relational Assessment, and the frequency of mental-state references made during mother–infant interactions was recorded. Temperament was assessed using the Revised Infant Temperament Questionnaire. Parents then completed questionnaires assessing whether their children had ICs at 44 months of age. The results revealed that only the approach characteristic of temperament marginally predicted children's IC status. Results of the parental measures showed that parents of children with ICs were more likely to attribute mental states to their child and to refrain from intruding in their child's behaviours than parents of children without ICs. The results indicated that parental behaviours are important for children's creation of ICs.     

Parents' emotion‐related beliefs and behaviours in relation to children's coping with the 11 September 2001 terrorist attacks

To assess relationships between parental socialization of emotion and children's coping following an intensely emotional event, parents' beliefs and behaviours regarding emotion and children's coping strategies were investigated after a set of terrorist attacks. Parents (n=51) filled out the Parents' Beliefs about Negative Emotions questionnaire and were interviewed within two weeks of the attacks. Their elementary and middle school‐aged children were interviewed eight weeks later. First, parents' beliefs were related to two kinds of parental behaviours. Parents' beliefs about both the value of and the danger of children's emotions were positively related to their discussion with their children. Parents' belief about children's emotions as dangerous was also negatively related to parents' expressiveness with their children. Second, parents' beliefs were related to five kinds of coping strategies reported by their children. Parents' belief about children's emotions as valuable predicted children's problem‐solving, emotion‐oriented, and support‐seeking coping following the terrorist attacks. Parents' belief about children's emotions as dangerous predicted children's avoidance and distraction coping following the attacks. Parents' beliefs about the importance of children's emotions may foster a family atmosphere that facilitates children's coping with intensely emotional events. Results support differentiated, multi‐faceted analysis of the broader construct of parental beliefs. Copyright © 2008 John Wiley & Sons, Ltd.     

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.     

Temperament and sleep–wake behaviour from infancy to toddlerhood

Sleep–wake behaviours and temperament were examined longitudinally for trait stability and relationship to behavioural state regulation from infancy to early childhood. Subjects were 120 low‐risk, full‐term infants from a middle class sample. At 6 weeks, parents completed three consecutive days of the Baby's Day Diary which measures sleep, wake, fuss, feed and cry states and the Infant Characteristics Questionnaire. At 16 months, parents assessed sleep behaviours with the Sleep Habits Inventory and temperament with the Toddler Symptom Checklist. At 24 months, parents repeated 3 days of the Baby's Day Diary. Structural Equation Modelling was used to examine the cross‐age hypotheses for sleep–wake and temperament associations. From early infancy to toddlerhood, sleep–wake behaviours and irritable temperament were notably stable but independent in this cohort. Copyright © 2011 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.     

Developmental trajectories of infant nighttime awakenings are associated with infant-mother and infant-father attachment security

This longitudinal study examined developmental trajectories of infant sleep problems from 3 to 24 months old and investigated associations with infant-parent attachment security and dependency. In a sample of 107 Israeli families, number and duration of infant nighttime awakenings were measured at 3, 6, 9, and 24 months old, using mothers’ and fathers’ reports on the Brief Infant Sleep Questionnaire (BISQ). Infant–parent attachment security and infant-parent dependency was assessed at 24 months old, using the observer Attachment Q-Sort procedure (AQS) with both parents. Latent growth curve models showed a non-linear decline in number and duration of infant nighttime awakenings over time. A higher number and longer duration of infant nighttime awakenings at 3 months were associated with higher infant-father attachment security at 24 months. In contrast, longer infant nighttime awakenings at 3 months were predictive of lower infant-mother attachment security at 24 months. A steeper decrease in duration of infant nighttime awakenings was associated with higher infant-father attachment security and lower infant-mother attachment security. As a potential mechanism, paternal involvement in nighttime caregiving was explored in relation to infant-father attachment security. Results of our post-hoc analyses revealed no significant associations between paternal involvement in nighttime caregiving and infant-father attachment security. Our results highlight the need to examine potential mechanisms explaining the divergent associations of infant sleep problems with infant-mother and infant-father attachment security in future research.     

Treatment of Infant Sleep Disturbance by Graduated Extinction

Chronic disturbed sleep is a common problem in preschool children. Treatment by extinction is successful but may be accompanied by side-effects such as post-extinction response bursts which make the treatment aversive to parents and which impairs their compliance. This study evaluated a modified procedure, graduated extinction, which required parents gradually to reduce attention to bedtime disturbance and night waking from average baseline levels to zero over 28 days. Baseline measures of frequency and duration of night waking, sleep-onset latency, and bedtime delay were made for six children (6- to 14-months-old). Parents were then instructed to use graduated extinction using a multiple-baseline-across-subjects design. Following treatment, three out of six children showed clinically significant reductions in the frequency and duration of night waking, and a fourth child substantially reduced the duration of her wakings. These gains were maintained at followup. Lack of improvement was associated with parental noncompliance with treatment and childhood illness. Two subjects showed some evidence of post-extinction response bursts despite the gradual withdrawal of parental attention. Parents reported high satisfaction with the procedures but half found the procedure mildly to moderately stressful. While graduated extinction was an effective treatment, regular extinction offers practical and clinical advantages in most cases.