Sleep patterns and sleep disruptions in kindergarten children

Assessed sleep patterns and sleep disruptions in kindergarten children and investigated the relation between sleep measures derived from objective and subjective evaluation methods. The sleep patterns of 59 normal kindergarten children (mean age = 5.5 years) were monitored for 4 to 5 consecutive nights by means of activity monitors (actigraph) and by means of parental daily sleep logs. The correlation between the actigraphic measures and the daily parental logs indicated that parents were accurate reporters of sleep schedule measures. However, parents were less accurate in assessing sleep quality measures, significantly underestimating the number of night-wakings and overestimating the quality of their children's sleep. Fragmented sleep was found, by means of activity monitoring, in 41% of the children.     

Sleep among presentations of Attention-Deficit/Hyperactivity Disorder: Analysis of objective and subjective measures

Background/ObjectiveTo examine subjective and objective sleep patterns in children with different Attention-Deficit/Hyperactivity Disorder (ADHD) presentations. Method: We assessed 92 children diagnosed with ADHD (29 ADHD-Inattentive [ADHD-I], 31 ADHD-Hyperactive/Impulsive [ADHD-H/I], and 32 ADHD-Combined [ADHD-C)]) aged 7–11 years. The Pediatric Sleep Questionnaire (PSQ), Pediatric Daytime Sleepiness Scale (PDSS), and a sleep diary were used as subjective sleep measures, and polysomnography was used to objectively assess sleep quantity, quality, and fragmentation. Results: Subjective data showed impaired sleep in 12.7% of the sample. No significant differences were found between ADHD presentations in any objective and subjective sleep variable. Nevertheless, data on sleep fragmentation suggested a worse sleep continuity for the ADHD-H/I group, and correlation analyses confirmed that sleep is affected by age. Conclusions: Children with ADHD may suffer from sleep breathing problems and daytime sleepiness, as reported by their parents, even when their total sleep time and sleep efficiency are not affected. It seems that sleep in this population does not largely vary as a function of the ADHD presentation. Sleep in children with ADHD evolves with age.     

The sleep patterns and problems of clinically anxious children

Childhood sleep problems have been associated with a range of adverse cognitive and academic outcomes, as well as increased impulsivity and emotional disorders such as anxiety and depression. The aim of the study was to examine subjective reports of sleep-related problems in children with anxiety disorders during school and weekend nights. Thirty-seven children with clinically-diagnosed anxiety disorders and 26 non-clinical children aged 7-12 years completed an on-line sleep diary to track sleep patterns across school nights and weekend nights. Anxious children reported going to bed significantly later (p = 0.03) and had significantly less sleep (p = 0.006) on school nights compared to non-anxious children. No significant differences in sleep onset latency, number of awakenings or time awake during the night, daytime sleepiness, or fatigue were found between the two groups. On the weekends, anxious children fell asleep quicker and were less awake during the night than on weeknights. School-aged anxiety disordered children showed a sleep pattern that differs from their non-anxious peers. Although the mean 30 min less sleep experienced by anxious children may initially seem small, the potential consequences on daytime performance from an accumulation of such a sleep deficit may be significant, and further investigation is warranted.     

The relationship between sleep problems and working memory in children born very preterm

In two studies, the relationship between sleep and working memory performance was investigated in children born very preterm (i.e., gestation less than 32 weeks) and the possible mechanisms underlying this relationship. In Study 1, parent-reported measures of snoring, night-time sleep quality, and daytime sleepiness were collected on 89 children born very preterm aged 6 to 7 years. The children completed a verbal working memory task, as well as measures of processing speed and verbal storage capacity. Night-time sleep quality was found to be associated with verbal working memory performance over and above the variance associated with individual differences in processing speed and storage capacity, suggesting that poor sleep may have an impact on the executive component of working memory. Snoring and daytime sleepiness were not found to be associated with working memory performance. Study 2 introduced a direct measure of executive functioning and examined whether sleep problems would differentially impact the executive functioning of children born very preterm relative to children born to term. Parent-reported sleep problems were collected on 43 children born very preterm and 48 children born to term (aged 6 to 9 years). Problematic sleep was found to adversely impact executive functioning in the very preterm group, while no effect of sleep was found in the control group. These findings implicate executive dysfunction as a possible mechanism by which problematic sleep adversely impacts upon cognition in children born very preterm, and suggest that sleep problems can increase the cognitive vulnerability already experienced by many of these children.     

Co-Sleeping among School-Aged Anxious and Non-Anxious Children: Associations with Sleep Variability and Timing

Little is known about the co-sleeping behaviors of school-aged children, particularly among anxious youth who commonly present for the treatment of sleep problems. The current study examined the occurrence of co-sleeping in both healthy and clinically anxious children and its associated sleep patterns. A total of 113 children (ages 6–12), 75 with primary generalized anxiety disorder and 38 healthy controls, participated along with their primary caregiver. Families completed structured diagnostic assessments, and parents reported on their child’s co-sleeping behaviors and anxiety severity. Children provided reports of anxiety severity and completed one week of wrist-based actigraphy to assess objective sleep patterns. A significantly greater proportion of anxious youth compared to healthy children co-slept, and greater anxiety severity was related to more frequent co-sleeping. Co-sleeping in anxious youth was associated with a delay in sleep timing and with greater sleep variability (i.e., more variable nightly sleep duration). All analyses controlled for child age, race/ethnicity, family income, and parental marital status. Co-sleeping is highly common in anxious school-aged children, with more than 1 in 3 found to co-sleep at least sometimes (2–4 times a week). Co-sleeping was even more common for youth with greater anxiety severity. Increased dependence on others to initiate and maintain sleep may contribute to poorer sleep in this population via shifted schedules and more variable sleep patterns.     

Effects of acute sleep restriction on behavior, sustained attention, and response inhibition in children.

This study examined the effects of acute sleep restriction on the day-time behavior and performance of healthy children and adolescents. 82 participants (8 to 15 years of age) completed 5 nights of baseline sleep and were randomly assigned to Optimized (10 hr.) or Restricted (4 hr.) sleep for an overnight lab visit. Behavior, performance, and sleepiness were assessed the following day. Sleep restriction was associated with shorter daytime sleep latency, increased subjective sleepiness, and increased sleepy and inattentive behaviors but was not associated with increased hyperactive-impulsive behavior or impaired performance on tests of response inhibition and sustained attention. Results are discussed in terms of current theories regarding effects of inadequate or disturbed sleep among children and adolescents.     

Children's objective and subjective sleep disruptions: links with afternoon cortisol levels.

OBJECTIVE: The purpose of this study was to determine possible relations between the quality and amount of children's sleep and cortisol in healthy children. DESIGN: Children's sleep was monitored with actigraphs for 7 nights. Children came to the laboratory to provide saliva samples, which were used to assess cortisol. Children reported on their sleepiness and sleep/wake problems. Sixty-four healthy children participated (M = 8.75 years; SD = .55). MAIN OUTCOME MEASURES: Self-reported sleepiness and sleep/wake problems, actigraphy-measured total sleep minutes, sleep efficiency, minutes awake after sleep onset, and sleep activity, and afternoon cortisol levels. Results: After controlling for demographic variables and child characteristics, higher levels of cortisol were related to increased subjective sleep problems and objective measures of shorter sleep duration and poorer sleep quality. CONCLUSION: These findings are of importance for understanding critical facets of children's health and well-being, and are noteworthy given the high prevalence of sleep disruptions in otherwise normally developing children in the United States.     

Child-rearing in an indigenous Sami population in Norway: a cross-cultural comparison of parental attitudes and expectations

Semi-structured interviews of 76 Sami mothers and 58 Sami fathers, and 86 Norwegian mothers and 58 Norwegian fathers of four-year olds, revealed consistent cross-cultural differences in parenting. ANCOVA results showed that parental permissiveness was higher in the Sami group. Moreover, the effect of ethnicity was different for boys and girls (mothers' reports). Co-sleeping and self-regulation of food and sleep were commonly practiced in the Sami, but not in the Norwegian families. Sami children were more socially independent than their Norwegian peers. Indirect or internal types of control were used more by Sami parents, and they were less tolerant of child aggression, in the form of temper tantrums and displays of jealousy. These patterns are similar to those found in other indigenous cultures in the circumpolar region. The results are discussed with reference to the Individualism-Collectivism dimension. The study challenges the Individualism-Collectivism construct for apparently confounding the individualism common in European liberalism with the individual autonomy commonly encountered among hunting-gathering peoples.     

Sleep disturbance and neuropsychological function in young children with ADHD

Sleep disturbance, common among children with ADHD, can contribute to cognitive and behavioral dysfunction. It is therefore challenging to determine whether neurobehavioral dysfunction should be attributed to ADHD symptoms, sleep disturbance, or both. The present study examined parent-reported sleep problems (Children’s Sleep Habits Questionnaire) and their relationship to neuropsychological function in 64 children, aged 4–7 years, with and without ADHD. Compared to typically developing controls, children with ADHD were reported by parents to have significantly greater sleep disturbance—including sleep onset delay, sleep anxiety, night awakenings, and daytime sleepiness—(all p ≤ .01), and significantly poorer performance on tasks of attention, executive control, processing speed, and working memory (all p < .01). Within the ADHD group, total parent-reported sleep disturbance was significantly associated with deficits in attention and executive control skills (all p ≤ .01); however, significant group differences (relative to controls) on these measures remained (p < .01) even after controlling for total sleep disturbance. While sleep problems are common among young children with ADHD, these findings suggest that inattention and executive dysfunction appear to be attributable to symptoms of ADHD rather than to sleep disturbance. The relationships among sleep, ADHD symptoms, and neurobehavioral function in older children may show different patterns as a function of the chronicity of disordered sleep.     

Fatigue risk management based on self-reported fatigue: Expanding a biomathematical model of fatigue-related performance deficits to also predict subjective sleepiness

Biomathematical models of fatigue can be used to predict neurobehavioral deficits during sleep/wake or work/rest schedules. Current models make predictions for objective performance deficits and/or subjective sleepiness, but known differences in the temporal dynamics of objective versus subjective outcomes have not been addressed. We expanded a biomathematical model of fatigue previously developed to predict objective performance deficits as measured on the Psychomotor Vigilance Test (PVT) to also predict subjective sleepiness as self-reported on the Karolinska Sleepiness Scale (KSS). Four model parameters were re-estimated to capture the distinct dynamics of the KSS and account for the scale difference between KSS and PVT. Two separate ensembles of datasets – drawn from laboratory studies of sleep deprivation, sleep restriction, simulated night work, napping, and recovery sleep – were used for calibration and subsequent validation of the model for subjective sleepiness. The expanded model was found to exhibit high prediction accuracy for subjective sleepiness, while retaining high prediction accuracy for objective performance deficits. Application of the validated model to an example scenario based on cargo aviation operations revealed divergence between predictions for objective and subjective outcomes, with subjective sleepiness substantially underestimating accumulating objective impairment, which has important real-world implications. In safety-sensitive operations such as commercial aviation, where self-ratings of sleepiness are used as part of fatigue risk management, the systematic differences in the temporal dynamics of objective versus subjective measures of functional impairment point to a potentially significant risk evaluation sensitivity gap. The expanded biomathematical model of fatigue presented here provides a useful quantitative tool to bridge this previously unrecognized gap.     

Developmental changes of parental-reported sleep disturbance symptoms in children with attention deficit disorder

The primary goal of this retrospective study was to assess parental report of current sleep disorders in school-aged attention deficit disorder (ADD) children, as well as recalled sleep problems from when the children were infants (0–12 months) and toddlers (1–3 years). Results of a sleep questionnaire completed by mothers of 48 ADD children and a comparison group of 30 patients with school problems indicate that ADD children were perceived to have significantly more sleep problems and that these problems had onset in infancy. Specific items in the questionnaire which were increased included latency to sleep onset of more than 30 min at least 3 nights per week, fatigue upon awakening, and recall of nightmares. Pediatric clinicians should be alert to possible sleep disorders in children suspected of attention disorders and should consider sleep hygiene measures as a component of treatment.     

Recovery of performance during sleep following sleep deprivation in older normal and insomniac adult males

Groups of 12 normal and insomniac male subjects aged 55 to 71 yr. were sleep deprived for 64 hr. In both groups, the sleep loss was preceded by four baseline sleep nights and followed by four recovery nights. Reaction time, immediate recall, sleepiness, and body temperature were measured at approximately 2300, 0115, 0330, 0530, and 0800 during baseline, deprivation and recovery nights. Significant performance or mood differences were not found between the normal and insomniac males on any measure or at any testing period throughout the study. Performance of both groups declined characteristically during sleep loss while subjective sleepiness increased. As in young adults, degraded performance was restored by 8 hr. of recovery sleep. However, subjective sleepiness did not return to baseline levels until early in the second recovery night. It was concluded that chronic insomnia does not result in group performance deficits similar to those seen after chronic sleep loss; and the restorative function of sleep operates as efficiently in older insomniac subjects (who apparently have reduced need to sleep) as in older normal subjects.     

Book reading styles in dual‐parent and single‐mother families

Background. Whereas many studies have investigated quantitative aspects of book reading (frequency), few have examined qualitative aspects, especially in very young children and through direct observations of shared reading. Aim. The purpose of this study was to determine possible differences in book‐reading styles between mothers and fathers and between mothers from single‐ and dual‐parent families. It also related types of parental verbalizations during book reading to children's reported language measures. Sample. Dual‐parent (29) and single‐parent (24) families were observed in shared book reading with their toddlers (15‐month‐olds) or young preschoolers (27‐month‐olds). Method. Parent–child dyads were videotaped while book reading. The initiator of each book‐reading episode was coded. Parents' verbalizations were exhaustively coded into 10 categories. Mothers completed the MacArthur Communicative Development Inventory, and the children were given the Bayley scales. Results. All parents differentiated their verbalizations according to the age rather than the gender of the child, but single mothers imitated female children more than males. Few differences in verbalizations were found between mothers and fathers or between mothers from single‐ and dual‐parent families. Fathers allowed younger children to initiate book‐reading episodes more than mothers. For both age groups of children, combined across families, verbalizations that related the book to the child's experience were correlated with reported language measures. Questions and imitations were related to language measures for the older age group. Conclusions. The important types of parental verbalizations during shared book reading for children's language acquisition are relating, questions and imitations.     

Prenatal Cocaine Exposure and Infant Sleep at 7 Months of age: The Influence of the Caregiving Environment

The primary goal of this study was to examine sleep problems in a sample of cocaine-exposed 7-month-old infants and to determine if maternal psychopathology mediated any existing association between substance exposure and sleep behaviors. We also examined the differences in sleep behaviors of cocaine-exposed infants in parental custody and cocaine-exposed infants in nonparental custody. Participants were 65 cocaine-exposed and 53 nonexposed infants and their primary caregivers who were recruited at delivery and assessed at 7 months of infant age. As expected, women who used cocaine during pregnancy had more psychiatric symptoms than nonusers. Prenatal exposure to heavier amounts of cocaine was significantly related to more severe sleep difficulties, and maternal anxiety mediated this association. Approximately 28% of cocaine mothers lost custody of their infants by 7 months of age. Nonmaternal caregivers had significantly fewer symptoms of psychopathology than the cocaine-using women who retained custody of their children. Infants who were in nonparental care at 7 months of age also had less severe sleep problems than did infants who remained in parental care.     

“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.     

Comparisons of children with delayed and normal language at 24 months of age on measures of behavioral difficulties,social and cognitive development

This investigation compared a group of expressive language-delayed children with language-normal children of the same age (M = 25.7 months; SD = 0.8 months) on various measures of development and behavioral difficulties. Data were obtained through language sampling, direct developmental assessment, and maternal reports of children's development and behavior. Scores on measures of social and cognitive development for children with language delay were found to be significantly lower than normals. Further, maternal reports indicated that these children displayed significantly more behavioral difficulties overall than did the language-normal children. Specifically, the language-delayed children exhibited more symptoms of anxiety and depression, withdrawal, sleep problems, and other behavioral disturbances. In addition, children evaluated as expressive language delayed scored significantly lower on measures of receptive language, maternal ratings of communicative competency, and other indices of language proficiency. The results point to the centrality of expressive and receptive language development in relation to early-appearing behavior problems and other developmental milestones. With these findings in mind, early language intervention may not only promote language development, but also prevent the development or exacerbation of socioemotional problems. © 1998 Michigan Association for Infant Mental Health     

Relative and absolute stability in perceived parenting behaviour: a longitudinal study with children and adolescents

Patterns of relative and absolute stability in parental behaviour with children and adolescents are reported. The sample comprised 523 youth (58.7% girls). Data were collected at three time periods: T1 (M age = 11.1 yr.), T2 (M age = 12.2 yr.), and T3 (M age = 13.2 yr.), each separated by one year. According to children's reports, relative consistency was moderate in both mothers and fathers, particularly as regards communication and strict control. In contrast, as children got older, parental rearing practices related to strict control and hostility decreased. There was a similarity between fathers and mothers in terms of relative and absolute stability. Relative stability was affected by the child's sex, the parenting variable, and the time period; however, the patterns of absolute stability reveal no differences by sex.     

Objective measures of executive functioning are highly discrepant with parent-report in fetal alcohol spectrum disorders

The purpose of the current study was to evaluate the relationship between parent-report and objective measures of executive function in children diagnosed with Fetal Alcohol Spectrum Disorder (FASD). The participants were a clinical sample of 551 children who completed 597 evaluations, including initial and re-evaluations. Participants were 6–16 years old, with a mean age of 10. Pearson correlations were used to determine the relationship between performance-based measures and parent-report measures of executive functioning. Relationships among the same types of measures, that is, performance based or parent report, were also evaluated. The data largely demonstrate low nonsignificant correlations between performance-based measures and parental report of executive function. Parent-report measures were internally consistent as were objective measures. It is possible that a third variable, for example, parental frustration, significantly influences parent reports. It is also likely that objective measures, which are administered in a controlled environment, do not fully capture children’s day-to-day functioning. That is, a child may have the executive function abilities (i.e., good performance on objective measures) but may be unable to deploy the appropriate skills in their daily lives, as evidenced by parental report. Children with FASD who have executive function abilities but not implementation skills likely require different interventions than children who lack abilities and skills.     

Parental behavior patterns and conduct disorders in girls

Conduct-disordered (CD) girls, 9 to 11 years old, were compared to nonconduct-disordered (NCD) girls of the same age using parental reports about themselves and their children and child reports of themselves and their parents. Correlations were obtained between parental behavior patterns and the behavior patterns of the girls as perceived by three family members: mother, father, and the target child. The results indicated that (1) parents of CD girls were more hostile in some contexts than parents of NCD girls, (2) relationships between parental behavioral characteristics and children's behavioral characteristics were stronger and more numerous for mothers than for fathers, and (3) the children's perception of their own behaviors and the parents' marriages tended to correspond with their parents' perceptions. In general, the pattern of results suggests that, in terms of aggressive behavior patterns, female children may be modeling the behavior of their parents, particularly that of their mothers.This research was supported in part by a Grant-in-Aid of Research awarded to the first author by Sigma Xi, the Scientific Research Society, and NIMH Grant No. MH35340. Portions of this paper were presented at the 18th Annual Convention of the Association for Advancement of Behavior Therapy, Philadelphia, November 1984.