Sleep problems of parents of typically developing children and parents of children with autism

Few researchers have investigated the relation of children's sleep problems to their parents' sleep problems. Children with autism have been reported to evidence greater sleep problems than do typically developing children (C. D. Hoffman, D. P. Sweeney, J. E. Gilliam, & M. C. Lopez-Wagner, 2006; P. G. William, L. L. Sears, & A. Allard, 2004). In the present study, parents (N = 106) of children independently diagnosed with autism (4-16 years of age; M= 8.20 years, SD = 2.69 years) reported greater sleep problems for themselves than did parents (N = 168) of typically developing children (4-15 years of age; M = 8.62 years, SD = 3.28 years). Children's sleep problems were related to parents' sleep problems for both groups; in the autism group, children's level of symptomatology was not related to their parents' sleep. The authors suggest areas for further research on the sleep problems of children and their parents, the potential interaction of these problems with children's symptomatic behavior, and the relations of these factors to child, parent, and family functioning.     

父子依恋、母子依恋与儿童应激下皮质醇反应的关系

本研究以北京115名五、六年级的学生为被试,采用儿童版特里尔社会应激测试(Trier Social Stress Test for Children,TSST-C),探究父子依恋、母子依恋与儿童应激下皮质醇反应的关系。研究分别在基线阶段、TSST-C开始前、TSST-C结束后、TSST-C结束后的10分钟、25分钟和50分钟收集儿童的唾液样本,并让儿童完成亲子依恋问卷。采用SPSS 20.0进行方差分析和回归分析。结果发现:(1)安全型父子依恋儿童的应激下皮质醇反应显著高于不安全型父子依恋儿童,反映在皮质醇值和皮质醇基于增加的曲线下面积(area under the curve with respect to increase,AUCI)两个指标上;(2)不同母子依恋类型儿童的应激下皮质醇反应(即皮质醇值和AUCI)不存在显著差异;(3)在控制了人口学变量之后,父子依恋依旧可以显著地正向预测儿童的皮质醇反应(皮质醇AUCI),但母子依恋对儿童皮质醇反应的预测作用不显著,且父子依恋对儿童皮质醇反应的预测作用边缘显著大于母子依恋对儿童皮质醇反应的预测作用。研究结果表明,安全型父子依恋与儿童应激下更高的皮质醇反应相关。     

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.     

Hormonal sensitivity of preterm versus full-term infants to the effects of maternal depression

Comparisons were made of differences in the hormonal sensitivity of preterm versus full-term infants to maternal depression, as reflected in children's cortisol levels. In Study 1 (N=25), a comparison was made between preterm versus healthy full-term children. In Study 2 (N=80), a comparison was made between preterm infants and full-term infants with mild or moderate medical problems. Preterm infants were found to be highly reactive to maternal depression (as measured by the Beck Depression Inventory). That is, they demonstrated higher cortisol levels when paired with depressed mothers and lower cortisol levels when paired with non-depressed mothers. No equivalent effects were found for children who were full-term, even when they had experienced other medical problems at birth. It was concluded that premature infants are exceptionally sensitive to the "emotional climate" in their home environment. As a result, they may manifest very different hormonal outcomes--with implications for their later development.     

Cognitive performance and morning levels of salivary cortisol and alpha-amylase in children reporting high vs. low daily stress perception

The aim of the present study was to assess the effects of daily stress perception on cognitive performance and morning basal salivary cortisol and alpha-amylase levels in healthy children aged 9-12. Participants were classified by whether they had low daily perceived stress (LPS, n = 27) or a high daily perceived stress (HPS, n = 26) using the Children Daily Stress Inventory (CDSI). Salivary cortisol and alpha-amylase were measured at awakening and 30 minutes later. Cognitive performance was assessed using the Cognitive Drug Research assessment system. The HPS group exhibited significantly poorer scores on speed of memory (p < .05) and continuity of attention (p < .05) relative to the LPS group. The HPS group also showed significantly lower morning cortisol levels at awakening and at +30 minutes measures in comparison with the LPS group (p < .05), and mean morning cortisol levels were negatively correlated with speed of memory (p < .05) in the 53 participants. No significant differences were observed between both groups in alpha-amylase levels. These findings suggest that daily perceived stress in children may impoverish cognitive performance via its modulating effects on the HPA axis activity.     

Circadian preference and perceived quality of the sleep/wake cycle in Italian high school students

We explored the relationship between circadian preference and perceived quality of the sleep/wake cycle in Italian high school students aged between 14 and 18 years. Three hundred and forty-five participants (299 females, 46 males) were administered the Morningness–Eveningness Questionnaire for Children and Adolescents (MEQ-CA) and the Mini Sleep Questionnaire (MSQ) to determine circadian preference and subjective quality of the sleep/wake cycle, respectively. The MSQ includes two main factors: sleep and wake; lower scores on these two factors correspond to a poorer quality of sleep and wake. Evening-type adolescents scored significantly lower than morning types on the wake factor. No significant effect of circadian preference was observed regarding the sleep factor. Our results suggest that Eveningness preference is significantly and negatively related to the perceived quality of the wake factor of Italian high school students.     

(Re)Conceptualizing Sleep Among Children with Anxiety Disorders: Where to Next?

Children with anxiety disorders (AD) characteristically complain of sleep problems and the extent to which cognitive behavioral treatments (CBT) for childhood anxiety produce sleep-based improvements is a topic of increasing interest. The current paper reviews available evidence for subjective sleep complaints and objective sleep alterations in children and adolescents with AD, including investigations of potential changes in sleep following anxiety-focused CBT. Despite pervasive complaints of poor sleep, the empirical literature provides minimal evidence for actual sleep–wake alterations in this population of youth and evidence for sleep-based changes following treatment for anxiety is minimal. In line with calls for more comprehensive models of the role of sleep in developmental psychopathology, several fundamental gaps in understanding are described and highlighted as essential avenues for clarifying the nature and consequences of poor quality sleep among youth with clinical levels of anxiety. In a second section of the paper, an emerging body of novel, translational research investigating more intricate sleep–anxiety relationships is introduced with potential implications for both etiological models and treatment design and delivery.     

The relationship between sleep and working memory in children with neurological conditions

The objective of this study is to investigate whether sleep problems might account for the increased working memory deficits observed in school-aged children with neurological conditions. A novel, transdiagnostic approach to the investigation was chosen, and sleep is treated as a process that can potentially account for working memory difficulties across a range of neurological conditions. Prevalence estimates of sleep problems are also examined. Archival data of 237 children aged 6 to 11 years were collected from a Western Australian statewide neuropsychological service for the period 26 July 2011 to 14 January 2014. Measures of parent-reported sleep quality, snoring, and daytime sleepiness were obtained, in addition to objective measures of verbal and spatial working memory, storage capacity, and processing speed. The results of the data analysis reveal that over one third of participants reported having clinically-significant levels of sleep problems and that poor sleep quality is significantly associated with verbal working memory difficulties. This association remains after partialling out the variance contributed to performance by storage capacity and processing speed, suggesting that sleep is impacting upon an executive component of working memory. No other significant associations are observed. The results suggest that poor sleep quality is associated with an executive component of verbal (rather than spatial) working memory in children with neurological conditions. This has implications for the biological mechanisms thought to underlie the relationship between sleep and cognition in children. The results also demonstrate the clinical utility of a transdiagnostic approach when investigating sleep and cognition in children with neurological conditions.     

Agreement rates for sleep/wake judgments obtained via accelerometer and sleep diary: A comparison

Agreement rates for waking and sleeping obtained via sleep diary and accelerometer were evaluated, to compare the two methods. Sleep/wake data for consecutive days and nights were surveyed in 119 healthy university students. Accelerometer sleep/wake judgments obeyed the standard algorithm. Agreement rates for waking and sleeping according to accelerometer versus sleep diary, respectively, were calculated. Sleep diary data were set as a baseline. Seventy-six subjects (63.9%), 22 to 32 years of age, presented perfect data for the analysis. The mean sleep times, in minutes, judged by sleep diary and by accelerometer, were 482.3 and 629.6, respectively. The mean percentages and standard deviations of agreement on wake and sleep were 77.5% (SD=10.2) and 86.1% (SD=6.2), respectively. There was a significant negative relationship between the agreement rates for wake and sleep (r=−.482, p<.01). The accelerometer showed some measurement failure during waking, presumably because of the decrease in body movement. Sleep diary data during daytime appear to be more valid for detecting a sleep/wake cycle than are accelerometer data. In contrast, nocturnal sleep diary data might be supplemented by the use of an accelerometer as long as participants do not have insomnia.     

A cross‐syndrome study of the differential effects of sleep on declarative memory consolidation in children with neurodevelopmental disorders

Sleep plays an active role in memory consolidation. Because children with Down syndrome (DS) and Williams syndrome (WS) experience significant problems with sleep and also with learning, we predicted that sleep‐dependent memory consolidation would be impaired in these children when compared to typically developing (TD) children. This is the first study to provide a cross‐syndrome comparison of sleep‐dependent learning in school‐aged children. Children with DS (n = 20) and WS (n = 22) and TD children (n = 33) were trained on the novel Animal Names task where they were taught pseudo‐words as the personal names of ten farm and domestic animals, e.g. Basco the cat, with the aid of animal picture flashcards. They were retested following counterbalanced retention intervals of wake and sleep. Overall, TD children remembered significantly more words than both the DS and WS groups. In addition, their performance improved following night‐time sleep, whereas performance over the wake retention interval remained stable, indicating an active role of sleep for memory consolidation. Task performance of children with DS did not significantly change following wake or sleep periods. However, children with DS who were initially trained in the morning continued to improve on the task at the following retests, so that performance on the final test was greater for children who had initially trained in the morning than those who trained in the evening. Children with WS improved on the task between training and the first retest, regardless of whether sleep or wake occurred during the retention interval. This suggests time‐dependent rather than sleep‐dependent learning in children with WS, or tiredness at the end of the first session and better performance once refreshed at the start of the second session, irrespective of the time of day. Contrary to expectations, sleep‐dependent learning was not related to baseline level of performance. The findings have significant implications for educational strategies, and suggest that children with DS should be taught more important or difficult information in the morning when they are better able to learn, whilst children with WS should be allowed a time delay between learning phases to allow for time‐dependent memory consolidation, and frequent breaks from learning so that they are refreshed and able to perform at their best.     

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.     

Sleep patterns and sleep disruptions in school-age children

This study assessed the sleep patterns, sleep disruptions, and sleepiness of school-age children. Sleep patterns of 140 children (72 boys and 68 girls; 2nd-, 4th-, and 6th-grade students) were evaluated with activity monitors (actigraphs). In addition, the children and their parents completed complementary sleep questionnaires and daily reports. The findings reflected significant age differences, indicating that older children have more delayed sleep onset times and increased reported daytime sleepiness. Girls were found to spend more time in sleep and to have an increased percentage of motionless sleep. Fragmented sleep was found in 18% of the children. No age differences were found in any of the sleep quality measures. Scores on objective sleep measures were associated with subjective reports of sleepiness. Family stress, parental age, and parental education were related to the child's sleep-wake measures.     

父母婚姻质量与儿童行为问题的追踪研究：儿童努力控制的调节作用

本研究采用母亲报告法,对474名学前儿童进行了为期一年的追踪研究,考察完整家庭中父母婚姻质量对儿童行为问题的影响,以及儿童努力控制的调节作用。结果表明:(1) 父母婚姻质量对学前儿童的外显和内隐行为问题均有即时的负向预测作用;(2) 儿童的努力控制对其当前、后期的外显和内隐行为问题均有负向预测作用;(3) 第一年儿童的努力控制对父母婚姻质量与儿童行为问题之间关系的调节作用成立。     

气质特征对学龄前儿童牙科治疗行为的影响

为探索气质特征对学龄前儿童牙科治疗行为的影响,本研究采用《中国学龄前儿童气质量表(CPTS)》测查了218名3~7岁首次接受牙科治疗儿童的气质特征,同时用Frankl Behavior Rating Scale(FBRS)对其牙科治疗行为进行评估。结果显示:适应性、趋避性及心境三个气质维度得分高的儿童出现牙科治疗行为问题几率大,其中适应性与牙科治疗行为问题相关性最大,气质类型为麻烦型、发动缓慢型儿童易出现牙科治疗行为问题,男孩较女孩更容易出现牙科治疗行为问题。本研究结果为临床儿童牙科医生如何应对有牙科治疗行为问题的儿童提供了理论依据,对如何进行牙科行为管理有一定的临床指导价值。     

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.     

Emotional and behavioural features of preschool children born by Caesarean deliveries at maternal request

Background: Caesarean deliveries at maternal request (CDMRs) are becoming increasingly common. There is still lack of evidence on potential postponed effect(s) of CDMRs on children's emotional and behavioural features, although such a possibility has been repeatedly postulated. This study aimed at evaluation of the emotional and behavioural characteristics in preschool children born from CDMRs. Methods: The study involved apparently healthy 5-year-old children from the community setting (40 born from CDMRs and 40 age and sex matched vaginally born controls). Inclusion criteria were: first-born singletons, delivery at term, the only children in families, married parents, and appropriate household conditions, absence of any inborn abnormalities, disabilities, chronic and progressive diseases. Children attended preschool day-care centres at the time of the study. The mothers were also presented with the Child Behaviour Checklist for Ages 1.5–5 years (CBCL1.5/5) aimed at assessing children's emotional and behavioural characteristics. Results: Children born from CDMRs presented with significantly higher values (more problems) on the following empirically based scales: anxiety/depression, withdrawal and sleep problems. They had statistically significantly higher values on so-called internalizing problems, both in girls and in boys. Associations remained significant after adjustment for major potential confounders. Conclusion: Children born from CDMRs may face more emotional disturbances and sleep problems at preschool age.     

Sleep-dependent consolidation of procedural motor memories in children and adults: the pre-sleep level of performance matters

In striking contrast to adults, in children sleep following training a motor task did not induce the expected (offline) gain in motor skill performance in previous studies. Children normally perform at distinctly lower levels than adults. Moreover, evidence in adults suggests that sleep dependent offline gains in skill essentially depend on the pre-sleep level of performance. Against this background, we asked whether improving children's performance on a motor sequence learning task by extended training to levels approaching those of adults would enable sleep-associated gains in motor skill in this age group also. Children (4-6 years) and adults (18-35 years) performed on the motor sequence learning task (button-box task) before and after ~2-hour retention intervals including either sleep (midday nap) or wakefulness. Whereas one group of children and adults, respectively, received the standard amount of 10 blocks of training before retention intervals of sleep or wakefulness, a further group of children received an extended training on 30 blocks (distributed across 3 days). A further group of adults received a restricted training on only two blocks before the retention intervals. Children after standard training reached lowest performance levels, whereas in adults performance after standard training was highest. Children with extended training and adults after reduced training reached intermediate performance levels. Only at these intermediate performance levels did sleep induce significant gains in motor sequence skill, whereas performance did not benefit from sleep in the low-performing children or in the high-performing adults. Spindle counts in the post-training nap were correlated with performance gains at retrieval only in the adults benefitting from sleep. We conclude that, across age groups, sleep induces the most robust gain in motor skill at an intermediate pre-sleep performance level. In low-performing children sleep-dependent improvements in skill may be revealed only after enhancing the pre-sleep performance level by extended training.     

学前儿童睡眠问题与语言障碍的关系

睡眠是个体身心健康发展的重要保障。学前期的睡眠问题可能会对儿童的行为、认知、语言和健康等诸多方面产生负面影响。研究表明, 睡眠呼吸障碍、夜间睡眠不足以及入睡困难等睡眠问题是学前儿童语言障碍的潜在威胁性因素。学者们提出了睡眠记忆巩固假说、警觉性假说和突触稳态假说来解释睡眠问题影响学前儿童语言发展的内在机制。这些研究结果为语言障碍的早期干预提供了一种新思路, 即通过行为干预、药物治疗、手术治疗和游戏干预等睡眠问题干预方式来提高学前儿童的语言能力。未来的研究可以进一步深入分析睡眠问题与语言障碍相关联的内在机制, 了解不同年龄段儿童睡眠问题与语言能力的关系, 以及探究融合教育背景下有效的游戏干预方式。     

The impact of parental borderline personality disorder on vulnerability to depression in children of affectively ill parents

Children of parents with major depressive disorder (MDD) are four to six times more likely than other children to develop MDD. Little research has examined whether comorbid parental diagnoses further increase children's risk. This study examines whether children of parents with comorbid MDD and Borderline Personality Disorder (BPD) (1) are at greater risk for experiencing depressive symptoms and/or episodes and (2) whether such increased risk may be due, in part, to their exhibiting higher levels of cognitive/interpersonal vulnerability factors. Children (n = 140; ages 6-14) of parents with MDD completed measures assessing cognitive/interpersonal vulnerability factors. Parents completed semi-structured clinical interviews assessing severity of current depressive symptoms and BPD. Both children and parents completed a semi-structured clinical interview assessing the child's current and past history of MDD. Children of parents with comorbid MDD and BPD exhibited higher levels of current depressive symptoms and higher levels of cognitive/interpersonal vulnerability factors than children of parents with MDD but no BPD, even after controlling for parents' current levels of depressive symptoms. The relationship between parental BPD and chil-dren's current levels of depressive symptoms was partially mediated by children's cognitive/interpersonal vulnerability factors. Last, children of parents with comorbid BPD and MDD were 6.84 times more likely to exhibit a current or past diagnosis of MDD.     

Cortisol and Children’s Adjustment: The Moderating Role of Sympathetic Nervous System Activity

We examined relations among cortisol, markers of sympathetic nervous system (SNS) activity (including salivary alpha-amylase and skin conductance level), and children's adjustment. We also tested the Bauer et al. (Journal of Developmental and Behavioral Pediatrics, 23(2), 102-113, 2002) hypothesis that interactions between the SNS and cortisol would be associated with internalizing and externalizing problems. Saliva samples were obtained from 8- to 9-year-olds before and after a laboratory assessment battery, and were assayed for cortisol and alpha-amylase (sAA). Basal skin conductance level (SCL) was measured during resting conditions. Parents reported on child adjustment. Interactions between basal SNS and cortisol levels explained moderate amounts of unique variance in children's externalizing and internalizing problems. More specifically, higher basal cortisol levels were positively associated with higher internalizing and externalizing problems among children with higher SNS activity, as compared to children with lower SNS activity. Findings underscore the utility of including information about the coordination between hypothalamic-pituitary-adrenal (HPA) and SNS activity in biosocial models of atypical child development.