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 effects of adults' affective expression and direction of visual gaze on 12‐month‐olds' visual preferences for an object following a 5‐minute, 1‐day,or 1‐month delay

Between 12‐ and 14 months of age infants begin to use another's direction of gaze and affective expression in learning about various objects and events. What is not well understood is how long infants' behaviour towards a previously unfamiliar object continues to be influenced following their participation in circumstances of social referencing. In this experiment, we examined infants' sensitivity to an adult's direction of gaze and their visual preference for one of two objects following a 5‐min, 1‐day, or 1‐month delay. Ninety‐six 12‐month‐olds participated. For half of the infants during habituation (i.e., familiarization), the adults' direction of gaze was directed towards an unfamiliar object (look condition). For the remaining half of the infants during habituation, the adults' direction of gaze was directed away from the unfamiliar object (look‐away condition). All infants were habituated to two events. One event consisted of an adult looking towards (look condition) or away from (look‐away condition) an object while facially and vocally conveying a positive affective expression. The second event consisted of the same adult looking towards or away from a different object while conveying a disgusted affective expression. Following the habituation phase and a 5‐min, 1‐day, or 1‐month delay, infants' visual preference was assessed. During the visual preference phase, infants saw the two objects side by side where the adult conveying the affective expression was not visible. Results of the visual preference phase indicate that infants in the look condition showed a significant preference for object previously paired with the positive affect following a 5‐min and 1‐day delay. No significant visual preference was found in the look condition following a 1‐month delay. No significant preferences were found at any retention interval in the look‐away condition. Results are discussed in terms of early learning, social referencing, and early memory.     

Learning unfamiliar faces in infants: The advantage of the regular sequence presentation and the three‐quarter view superiority

We investigated the effect of the regular sequence of different views and the three‐quarter view effect on the learning of unfamiliar faces by infants. 3–8‐month‐old infants were familiarized with unfamiliar female faces in either the regular condition (presenting 11 different face views from the frontal view to the left‐side profile view in regular order) or the random condition (presenting the same 11 different face views in random order). Following the familiarization, infants were tested with a pair of a familiarized and a novel female face either in a three‐quarter (Experiment 1) or in a profile view (Experiment 2). Results showed that only 6–8‐month‐old infants could identify a familiarized face in the regular condition when they were tested in three‐quarter views. In contrast, 6–8‐month‐old infants showed no significant novelty preference in profile views. The results suggest that the regular sequence of different face views promotes the learning of unfamiliar faces by infants over 6 months old. Moreover, our findings imply that the three‐quarter view effect appears in infants.     

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.     

Longitudinal Assessment of Sleep–Wake Regulation and Attachment Security with Parents

The development of sleep–wake regulation occurs within the context of the infant–parent relationship. The present study investigated (1) patterns of change in night waking across infancy and attachment to parents and (2) if dependency, a characteristic of secure subgroup B4 and insecure‐resistant infants, accounted for differences in night waking. Forty‐six families reported on the number of infant night wakings at 7, 12, and 14 months of age. Attachment was measured at 12 (infant–mother) and 14 (infant–father) months. Findings suggest that infants with a secure (including the dependent‐secure, B4) pattern of attachment with mothers decreased in the number of night wakings over time, whereas infants with an insecure‐resistant pattern of attachment with mothers continued to wake at night into the second year. Attachment dependency did not account for differences in night waking. These findings are important to understanding the mechanism(s) underlying the relation between attachment and sleep–wake regulation. Copyright © 2012 John Wiley & Sons, Ltd.     

The Ontogeny of Long‐Term Retention During the Second Year of Life

Developmental changes in retention were assessed in two experiments with 18‐ and 24‐month‐old infants. In both experiments, infants were tested in a deferred imitation paradigm. In Experiment 1, independent groups of infants were tested either immediately or after delays of 1, 14, 28 or 56 days. There was no age‐related difference in the spontaneous production of target actions (baseline) or in immediate imitation. There were age‐related changes in retention after longer delays. Eighteen‐month‐olds exhibited retention for 14 days and 24‐month‐olds exhibited retention for at least 56 days. In Experiment 2, the maximum duration of retention by 24‐month‐olds was assessed. Independent groups of infants were tested after 3 or 6 months. Infants exhibited some evidence of retention after 3 months; however, forgetting was complete after 6 months.     

Sensorimotor EEG operant conditioning: Experimental and clinical effects

Neurophysiological studies in cats have established a functional relationship between waking 12–15 Hz sensorimotor cortex rhythmic EEG activity (the sensorimotor rhythm or SMR) and a similar pattern during sleep, the sleep spindle. Both result from oscillatory thalamocortical discharge involving ventrobasal thalamus and sensorimotor cortex, and both are associated with a state of suppressed motor excitability. Enhancement of the SMR with operant conditioning methods in the cat clearly led to reduced seizure susceptibility. The experimental application of this approach to seizure control in epileptics has resulted in (A) evidence that EEG patterns can be manipulated significantly in man with operant conditioning, (B) suggestive observations concerning a potential component of pathology in epilepsy, and (C) strong preliminary evidence that SMR operant conditioning in epileptics is specifically therapeutic. Current research has focused upon the EEG during sleep in epileptics with primary motor symptomatology. This measure often reveals several hard signs of pathology. These include the presence of abnormal activity in the 4–7 Hz frequency band and the absence or disturbance of activity in the 11–15 Hz frequency band. Power spectral analysis is being utilized to quantify these sleep EEG components in five groups of epileptic patients, studied with different frequency patterns rewarded in an A-B-A design which provides for counterbalancing of order effects. Initial laboratory training is followed by 9–12 months of training at home with portable feedback equipment. Reward contingencies are reversed within each group at approximately three month intervals. Clinical EEG data, blood anticonvulsant measures and patient seizure logs supplement sleep EEG data obtained before training and after each phase of the design. Early results have again indicated specific therapeutic benefits following training of high frequency rhythmic central cortical activity.     

Does contingency in adults’ responding influence 12-month-old infants’ social referencing?

In two experiments we examined the influence of contingent versus non-contingent responding on infant social referencing behavior. EXPERIMENT 1: Forty 12-month-old infants were exposed to an ambiguous toy in a social referencing situation. In one condition an unfamiliar adult who in a previous play situation had responded contingently to the infant’s looks gave the infant positive information about the toy. In the other condition an unfamiliar adult who previously had not responded contingently delivered the positive information. EXPERIMENT 2: Forty-eight 12-month-old infants participated in Experiment 2. In this experiment it was examined whether the familiarity of the adult influences infants’ reactions to contingency in responding. In one condition a parent who previously had responded contingently to the infant’s looks provided positive information about the ambiguous toy, and in the other condition a parent who previously had not responded contingently provided the positive information. The infants looked more at the contingent experimenter in Experimenter 1, and also played more with the toy after receiving positive information from the contingent experimenter. No differences in looking at the parent and in playing with the toy were found in Experiment 2. The results indicate that contingency in responding, as well as the familiarity of the adult, influence infants’ social referencing behavior.     

Does contingency in adults’ responding influence 12-month-old infants’ social referencing?

In two experiments we examined the influence of contingent versus non-contingent responding on infant social referencing behavior. EXPERIMENT 1: Forty 12-month-old infants were exposed to an ambiguous toy in a social referencing situation. In one condition an unfamiliar adult who in a previous play situation had responded contingently to the infant’s looks gave the infant positive information about the toy. In the other condition an unfamiliar adult who previously had not responded contingently delivered the positive information. EXPERIMENT 2: Forty-eight 12-month-old infants participated in Experiment 2. In this experiment it was examined whether the familiarity of the adult influences infants’ reactions to contingency in responding. In one condition a parent who previously had responded contingently to the infant’s looks provided positive information about the ambiguous toy, and in the other condition a parent who previously had not responded contingently provided the positive information. The infants looked more at the contingent experimenter in Experimenter 1, and also played more with the toy after receiving positive information from the contingent experimenter. No differences in looking at the parent and in playing with the toy were found in Experiment 2. The results indicate that contingency in responding, as well as the familiarity of the adult, influence infants’ social referencing behavior.     

Correlates of social support receipt

Psychological correlates of social support receipt were examined in an investigation of stress and coping among 150 middle-aged community residents. Subjects were interviewed monthly for 6 months, each time concerning a specific stressful situation in the previous month. Social support received and methods of coping were assessed each time, as well as other variables. Factors hypothesized to be associated with support receipt were person predispositions, appraisal patterns with regard to specific stressful encounters, and coping strategies used. Each was most strongly associated with a particular type of social support. Person predispositions related most strongly to emotional support received, appraisal factors related most strongly to aid, and coping strategies related most to informational support received. Furthermore, of the three sets of variables, the individual's ways of coping appeared to be most strongly associated with all types of social support received. Two implications are explored. First, we suggest that the three types of social support studied represent different constructs with different antecedents and consequences. Second, we argue that coping behavior provides interpersonal cues regarding what is wanted or needed in a stressful situation and that the members of the social environment respond accordingly.     

Sleep arrangements and night waking at 6 and 12 months in relation to infants' stress‐induced cortisol responses

The objective of this short‐term longitudinal study was to examine the concurrent and prospective associations of infants' sleep arrangements and night waking with cortisol responses to an inoculation at 6 and 12 months, controlling for several key covariates. To our knowledge, this was the first study to concurrently and prospectively link proximity in sleep arrangements and night waking to physiological stress reactivity. A sample of 92 mother–infant dyads participated in the study when the infants were 6 and 12 months of age, although sample sizes were reduced for some analyses. Both proximal cosleeping arrangements and more frequent night wakings' were associated concurrently with an increased cortisol response to inoculations at both ages. Night waking at 6 months also was associated with a slightly increased cortisol response to inoculation at 12 months. Results aimed at exploring the direction of influence suggested that cosleeping and night waking may influence infant stress physiology rather than the reverse. Adaptive and maladaptive implications of infants' nocturnal experiences and greater stress‐induced cortisol responses are discussed. Copyright © 2009 John Wiley & Sons, Ltd.     

Affective matching of odors and facial expressions in infants: shifting patterns between 3 and 7 months

Recognition of emotional facial expressions is a crucial skill for adaptive behavior. Past research suggests that at 5 to 7 months of age, infants look longer to an unfamiliar dynamic angry/happy face which emotionally matches a vocal expression. This suggests that they can match stimulations of distinct modalities on their emotional content. In the present study, olfaction–vision matching abilities were assessed across different age groups (3, 5 and 7 months) using dynamic expressive faces (happy vs. disgusted) and distinct hedonic odor contexts (pleasant, unpleasant and control) in a visual‐preference paradigm. At all ages the infants were biased toward the disgust faces. This visual bias reversed into a bias for smiling faces in the context of the pleasant odor context in the 3‐month‐old infants. In infants aged 5 and 7 months, no effect of the odor context appeared in the present conditions. This study highlights the role of the olfactory context in the modulation of visual behavior toward expressive faces in infants. The influence of olfaction took the form of a contingency effect in 3‐month‐old infants, but later evolved to vanish or to take another form that could not be evidenced in the present study.     

The effect of situation familiarity on the establishment of co-references between mother and infant

The purpose of this study was to determine whether the familiarity or the novelty of play objects available during mother-infant interaction has an effect on the mother's ability to capture and maintain the infant's attention. Twelve mother-infant dyads with 5- and 9-month-old infants were filmed during two 5-minute sessions with familiar or unfamiliar toys. Changes in the infant's visual orientation preceded by a maternal behaviour within a 3-sec interval were studied. In the familiar toy situation, the infants focused more frequently on the maternal referent than with the unfamiliar toys. The mother's verbal and non-verbal interventions were more effective at initiating and maintaining co-reference, because the infant was more frequently in an receptive state. Conversely, when the toys were unfamiliar, the baby was often the initiator. Unfamiliar objects, which appear more attractive, may compete with the mother's attempts to gain the child's attention.     

Infants' attribution of a goal to a morphologically unfamiliar agent

How do infants identify the psychological actors in their environments? Three groups of 12‐month‐old infants were tested for their willingness to encode a simple approach behavior as goal‐directed as a function of whether it was performed by (1) a human hand, (2) a morphologically unfamiliar green object that interacted with a confederate and behaved intentionally, or (3) the same unfamiliar green object that behaved in a matched, but apparently random manner. Using a visual habituation technique, only infants in the first two conditions were found to encode the approach behavior as goal‐directed. Thus infants appear able to attribute goals to non‐human, even unfamiliar agents. These results imply that by the end of the first year of life infants have a broad notion of what counts as an agent that cannot easily be reduced to humans, objects that are perceptually similar to humans, or objects that display self‐propulsion.     

Effects of adults’ contingent responding on infants’ behavior in ambiguous situations

We examined the effect of adults’ contingency in responding to infants’ behavior in an ambiguous situation in two experiments. In Experiment 1, forty-four 12-month-old infants were exposed to an ambiguous toy. An unfamiliar adult responded either contingently or non-contingently to the infant’s bids and then presented the toy and provided positive information. During toy presentation, infants in the non-contingent condition looked less at the experimenter than infants in the contingent condition. In a concluding free-play situation infants in the non-contingent condition played less and tended to touch the toy less. In Experiment 2 (forty-four 12-month-old infants), the parent either responded promptly or with a delay each time the infant made contact initiatives and then presented an ambiguous toy and delivered the positive information. The infants in the non-contingent condition tended to look less at the parent during toy presentation and also tended to play less with the toy during the concluding free-play situation. The findings show that adults’ contingency in responding influences infants’ behavior in ambiguous situations.     

My mother is sensitive,but I am too tired to know: Infant sleep as a moderator of prospective relations between maternal sensitivity and infant outcomes

This study investigated the moderating role of infant sleep in the connections between maternal sensitivity and three indicators of infant functioning: attachment security, theory of mind, and executive functioning (EF). Maternal sensitivity was assessed when infants (27 girls and 36 boys) were 1 year of age. Infant sleep was assessed with actigraphy at age 2; attachment security, theory of mind, and EF were also assessed at age 2. Results indicated that maternal sensitivity was positively related to attachment security only among infants who got more sleep at night, and to conflict-EF and theory of mind only for infants who got greater proportions of their sleep during the night. These results suggest that sleep may enhance the benefits of maternal sensitivity for some aspects of infants’ functioning, providing further support for the importance of sleep maturation as a salient developmental task of infancy.     

Prior sleep timing and visual recognition of emotional faces in 6-month-old infants

Face recognition is an important mnemonic ability for infants when navigating the social world. While age-related changes in face processing abilities are relatively well documented, less is known about short-term intra-individual fluctuations in this ability. Given that sleep deprivation in adults leads to impairments in information processing, we assessed the role of prior sleep on 6-month-old infants’ (N = 17) visual recognition of faces showing three emotional expressions (neutral, sad, angry). Visual recognition was inferred by assessing novelty preferences for unfamiliar relative to familiarized faces in a visual recognition memory paradigm. In a within-subject design, infants participated once after they had recently woken up from a nap (nap condition) and once after they had been awake for an extended period of time (awake condition). Infants failed to show visual recognition for the neutral faces in either condition. Infants showed recognition for the sad and angry faces when tested in the awake condition, but not in the nap condition. This suggests that timing of prior sleep shapes how effectively infants process emotionally relevant information in their environment.     

Intrinsic and extrinsic factors associated with night waking in 9-month-old infants

This study examined relations between infant night waking and both daytime behaviors reflective of poor behavioral and emotional regulation (intrinsic factors) and parent behaviors that may contribute to infant night waking (extrinsic factors) in 41 infants. Mothers completed questionnaires and an infant sleep and crying diary. More time awake at night was related to separation distress, frequent daytime crying, dysregulation, co-sleeping with parents, breast feeding, and being put to bed asleep. More frequent waking was related to separation distress, frequent daytime crying, co-sleeping, and breast feeding. The combination of intrinsic and extrinsic factors predicted night waking better than behaviors from one category alone. Implications for parenting are discussed.     

Effects of total sleep loss on sleep tendency.

Effects of two nights of sleep loss were assessed in six young adult (18--21 yr.) volunteers (2 women, 4 men). Performance on the Wilkinson Addition Test fell significantly below baseline values during the sleep-loss procedure and recovered after one or two full nights of sleep. Performance on a Serial Alternation Task also declined during sleep loss. Mood and sleepiness, assessed by subjective self-rating scales, showed a significantly less positive mood and a greater degree of sleepiness during sleep loss, with a recovery to baseline levels after one full night of sleep. Sleep tendency, measured at 2-hr. intervals during all waking periods, was assessed using an objective measure of latency to sleep onset, the Sleep Latency Test. The scores fell to about 1 min. at 0600 on the first night of sleep loss and remained at similarly low values throughout the sleep loss period. After one night of recovery sleep the scores remained significantly below baseline levels, which were not achieved until after the second recovery night. The multiple sleep latency test appears to be a valuable operationally defined tool for measuring daytime sleepiness.     

Shared musical knowledge in 11‐month‐old infants

Five‐month‐old infants selectively attend to novel people who sing melodies originally learned from a parent, but not melodies learned from a musical toy or from an unfamiliar singing adult, suggesting that music conveys social information to infant listeners. Here, we test this interpretation further in older infants with a more direct measure of social preferences. We randomly assigned 64 11‐month‐old infants to 1–2 weeks’ exposure to one of two novel play songs that a parent either sang or produced by activating a recording inside a toy. Infants then viewed videos of two new people, each singing one song. When the people, now silent, each presented the infant with an object, infants in both conditions preferentially chose the object endorsed by the singer of the familiar song. Nevertheless, infants’ visual attention to that object was predicted by the degree of song exposure only for infants who learned from the singing of a parent. Eleven‐month‐olds thus garner social information from songs, whether learned from singing people or from social play with musical toys, but parental singing has distinctive effects on infants’ responses to new singers. Both findings support the hypothesis that infants endow music with social meaning. These findings raise questions concerning the types of music and behavioral contexts that elicit infants’ social responses to those who share music with them, and they support suggestions concerning the psychological functions of music both in contemporary environments and in the environments in which humans evolved.