Disorders of excessive crying,feeding, and sleeping: The Munich Interdisciplinary Research and Intervention Program

The Munich Interdisciplinary Research and Intervention Program (MIRIP 1991) is an inter-disciplinary diagnostic and intervention service for families with regulatory disturbed infants (excessive crying, feeding/sleeping disturbances, disturbances of attachment/exploration, disturbances of autonomy/control). In addition, the systematic collection of data serve to investigate the etiology, clinical course, and possible treatments of regulatory problems in infancy. The program is based on a systemic model of early developmental psychopathology. Diagnostic procedures include a semistructured clinical interview, a developmental neuropediatric examination; behavioral diaries; questionnaires on infant temperament, the mother's psychological condition, marital satisfaction, and social support; and videotaped mother–infant interactions in age-related contexts. As is evident from the data analysis, regulatory disturbances in infancy may be associated with (1) maladaptive regulatory patterns in several domains (e.g., excessive crying and disturbed sleep-wake organization), (2) high maternal distress and multiple psychosocial risk factors, and (3) considerable distress of the early mother/parent–infant relationship and communication. Interaction-centered infant–parent psychotherapy is an interdisciplinary, multidimensional therapeutic approach for families with regulatory disturbed infants. It targets upon dysfunctional patterns of mother/parent–infant communication. Particular emphasis is put on restoring the parents' intuitive capacities. The approach has proved to be effective within short time periods and aims at preventing later developmental problems. © 1998 Michigan Association for Infant Mental Health     

Temperament profiles from infancy to middle childhood: development and associations with behavior problems

The authors applied I-States as Objects Analysis (ISOA), a recently proposed person-oriented analytic approach, to the study of temperament development in 921 Norwegian children from a population-based sample. A 5-profile classification based on cluster analysis of standardized mother reports of activity, sociability, emotionality, and shyness at ages 18 months, 30 months, 4-5 years, and 8-9 years was interpretable and highly replicable. The prevalence of temperament profiles changed markedly with age, and individual stability in temperament profiles was significant. Specific typical and atypical developmental sequences of profiles were identified. Selective patterns of concurrent group differences in externalizing and internalizing problems by temperament profiles were remarkably similar across ages. The findings to some degree support the notion that individual temperament-variable values take on meaning in relation to the whole individual configuration and indicate some lawfulness in temperament changes over time. Future person-oriented studies of temperament development should replicate the current results using multiple data sources, rigorous tests of gender differences, and latent group modeling. (PsycINFO Database Record (c) 2008 APA, all rights reserved).     

Treatment of sleep problems in a toddler: a replication of the faded bedtime with response cost protocol.

Multiple sleep problems of a 2-year-old girl improved following treatment with a faded bedtime with response cost procedure (Piazza & Fisher, 1991). These results extend the literature by implementing treatment in a home setting with a nondisabled child using the parents as therapists.     

Therapeutic interventions in infancy: Two contrasting cases of persistent crying

Infants are liable to many symptoms of emotional disturbance. However, it is now widely agreed that there is no such thing as individual psychopathology in infancy. Infantile disturbances are considered to be a function of current relationships. The paper briefly summarises available psychodynamic approaches to problems in infant relationships. It argues that more case-studies of therapeutic interventions in infancy are needed to increase our understanding of early disturbances and of their treatment. Two contrasting case-studies of intervention in persistent crying attempt to understand what may sustain this distressing problem. In each case the possible meaning of the crying, both to the babies and to their families, is considered.     

Persistent crying and parenting: Search for a butterfly in a dynamic system

The risks and causes of persistent crying in early infancy are discussed on the basis of a study of 61 infants referred to the Munich Interdisciplinary Research and Intervention Program for Fussy Babies for persistent crying between 1 and 6 months of age, and of a community sample of 51 infants of the same age. Particular attention was paid to pre-verbal parent-infant communication, the development of which was interpreted in terms of a dynamic interactional system including both regulatory and communicative predispositions in infants and intuitive competence for supporting infant predispositions in parents. Neither a gut problem nor any other single causal factor was identified for persistent crying in the majority of cases. In contrast, persistent crying was significantly associated with multiple biological and psychosocial risk factors for both parents and infants. Neurological immaturity, difficult temperament and sleep problems in infants, and impaired psychological conditions, limited resources and failures of intuitive competences in mothers were found to threaten the developmental process in infants and give rise to ‘vicious circles’ which were destabilizing the interactional systems. Increased attention to intuitive parental competences is recommended as one effective model for therapeutic interventions.     

An evaluation of food type and texture in the treatment of a feeding problem

An evaluation of food type and texture indicated that both variables affected the expulsions of a 3-year-old with feeding problems. The results of the evaluation were used to prescribe a treatment (reducing the texture of one food type) that reduced expulsion.     

Noncontingent and differential reinforcement in the treatment of pediatric feeding problems

We conducted functional analyses of the inappropriate mealtime behavior of 5 children diagnosed with feeding problems. Then, we compared the effects of differential and noncontingent reinforcement, and the relative effects of escape extinction with and without differential or noncontingent reinforcement, when escape extinction appeared necessary. Both reinforcement procedures were effective without escape extinction to treat food refusal for 1 child, but only differential reinforcement was effective without escape extinction to treat the child's liquid refusal. Escape extinction was necessary for 4 of 5 children. The addition of positive reinforcement resulted in beneficial effects (i.e., more stable acceptance, decreased inappropriate mealtime behavior or negative vocalizations) with 3 of 4 children. With escape extinction, differential reinforcement was more effective to treat food refusal for 2 children and noncontingent reinforcement was more effective for 1 child.     

Sucking patterns are not predictive of further feeding development in healthy preterm infants

Preterm infants are at risk of experiencing difficulties in their feeding development. For a possible early identification of these, we examined the association between sucking patterns, assisted spoon feeding, and chewing skills in 40 healthy preterm infants, and the role of experience in the acquisition of these skills in a prospective longitudinal study. Sucking patterns were evaluated at 34, 37, and 44 weeks postmenstrual age (PMA), assisted spoon feeding was evaluated at 6, 9, and 12 months PMA, and chewing was evaluated at 9, 12, and 24 months PMA. Sucking patterns were rated using the Neonatal Oral Motor Assessment Scale, assisted spoon feeding was rated using the Observation List Spoon Feeding, and chewing was evaluated using the Mastication Observation and Evaluation Instrument.All infants showed progression in their oral motor skills during the study period, but not all demonstrated a stable progression of skills. Quality of sucking patterns was not associated with skill level achievement of assisted spoon feeding or with chewing. Length of experience in sucking was significantly associated with duration of supplemental tube feeding but not with the quality of the sucking pattern. Length of chewing experience was significantly associated with chewing abilities at 9 and 12 months PMA. No clinical characteristics were sufficiently predictive of oral motor skill development. Results show that sucking patterns are not predictive of subsequent feeding development in healthy preterm infants. The food consistency offered and the length of feeding experience influenced the acquisition and quality of oral motor skills differently.     

Escape as reinforcement and escape extinction in the treatment of feeding problems

Given the effectiveness of putative escape extinction as treatment for feeding problems, it is surprising that little is known about the effects of escape as reinforcement for appropriate eating during treatment. In the current investigation, we examined the effectiveness of escape as reinforcement for mouth clean (a product measure of swallowing), escape as reinforcement for mouth clean plus escape extinction (EE), and EE alone as treatment for the food refusal of 5 children. Results were similar to those of previous studies, in that reinforcement alone did not result in increases in mouth clean or decreases in inappropriate behavior (e.g., Piazza, Patel, Gulotta, Sevin, & Layer, 2003). Increases in mouth clean and decreases in inappropriate behavior occurred when the therapist implemented EE independent of the presence or absence of reinforcement. Results are discussed in terms of the role of negative reinforcement in the etiology and treatment of feeding problems.     

The effectiveness of function‐based interventions to treat sleep problems,including unwanted co‐sleeping,in children with autism

This study investigated the effectiveness of functional behavioral assessment (FBA)—informed interventions for sleep problems, particularly co‐sleeping, in children with autism spectrum disorder (ASD). Seven children, who exhibited multiple sleep problems including unwanted co‐sleeping, participated. FBA, based on information derived from interviews and parent‐recorded sleep diaries, was used to develop individualized case formulations upon which multicomponent, parent‐implemented interventions were based. These were evaluated using a single‐case, non‐concurrent multiple‐baseline‐across‐participants design. Improvements were observed across all sleep problems, including the elimination of co‐sleeping. Gains were maintained at follow‐up for five out of seven children, though two children did not complete intervention. Parents reported high levels of satisfaction with the program. FBA‐based interventions for sleep problems in children with ASD and their clinical implications are further discussed.     

Strategies for coping with career indecision: Concurrent and predictive validity

Recently, Lipshits-Braziler, Gati, and Tatar (2015a) proposed a model of strategies for coping with career indecision (SCCI), comprising three main types of strategies: Productive coping, Support-seeking, and Nonproductive coping. Using a two-wave longitudinal design (30-week time lag), the effects of these strategies on career decision status and career decision-making difficulties were tested among 251 students in a college preparatory program. The results showed that the use of Nonproductive coping strategies at the beginning of the program was associated with and predicted a higher degree of individuals' career decision-making difficulties, and also distinguished between decided and undecided participants at both the beginning and the end of the program, thus partially supporting the concurrent and the predictive validity of the SCCI. Furthermore, a decrease in the use of Nonproductive strategies over time predicted a decrease in individuals' career decision-making difficulties. In addition, a decrease in the use of Nonproductive coping strategies and an increase in the use of Productive ones predicted individuals' advancement toward making a career decision. Theoretical and counseling implications are discussed.     

Trajectories of sleep problems among adolescents after the Wenchuan earthquake: the role of posttraumatic stress disorder symptoms

Objective: We examined the trajectories of sleep problems in adolescents after the Wenchuan earthquake, and assessed predictors such as posttraumatic stress disorder symptoms. Methods: We surveyed adolescents at 1, 1.5, 2, and 2.5 years after the Wenchuan earthquake. In total, 391 adolescents completed self-report questionnaires. Results: We identified five latent sleep problem trajectories, specifically, U-shaped (3.8%), low-stable (68.0%), high-stable (10.8%), increasing (8.7%), and decreasing (8.7%) trajectories. Additionally, we found that posttraumatic stress disorder hyper-arousal symptoms were more frequent in individuals who had non-low-stable trajectories. Adolescents in the U-shaped group were less likely to have intrusive symptoms. Conclusion: After natural disasters, consequent sleep problems in adolescents do not remain stable over time, and sleep problem trajectories had considerable heterogeneity.     

Sedentary behaviour and sleep problems among young,middle-aged,and older persons in South Africa: A brief report

The study aimed to investigate the relationship between sedentary behaviour and sleep problems in a large national community sample in South Africa. We analysed an existing cross-sectional population data set, the “South African National Health and Nutrition Examination Survey”. The sample included 13 555 individuals (median age 34.0 years, interquartile range 25, range 15–98 years). Overall, the study population engaged < 4 hours (49.5%), 4 – < 8 hours (37.2%), 8 – < 11 hours (9.7%), and 11 or more hours (3.6%) in sedentary time a day. The prevalence of sleeping problems was 6.4% and 6.7% in the less than 4 and less than 8 hours sedentary time categories, respectively. The prevalence of sleeping problems was 9.8% and 9.4% in the less than 11 hours and 11 or more hours sedentary time categories, respectively. In the final adjusted logistic regression model, among 50 years and older, the highest sedentary time category was associated with sleep problems, while there was no association in the younger (15–49 years) age group and in the overall model. This could mean that persons at older age with sedentary behaviour are at an increased risk of sleep problems.     

Transitions in sleep problems from late adolescence to young adulthood: A longitudinal analysis of the effects of peer victimization

Adolescence is a developmental period with high vulnerability to sleep problems. However, research identifying distinct patterns and underlying determinants of sleep problems is scarce. This study investigated discrete subgroups of, changes in, and stability of sleep problems. We also examined whether peer victimization influenced sleep problem subgroups and transitions in patterns of sleep problems from late adolescence to young adulthood. Sex differences in the effects of peer victimization were also explored. In total, 1,455 male and 1,399 female adolescents from northern Taiwan participated in this longitudinal study. Latent transition analysis was used to examine changes in patterns of sleep problems and the effects of peer victimization on these changes. We identified three subgroups of sleep problems in males and two in females, and found that there was a certain level of instability in patterns of sleep problems during the study period. For both sexes, those with greater increases in peer victimization over time were more likely to change from being a good sleeper to a poor sleeper. The effects of peer victimization on baseline status of sleep problems, however, was only significant for males, with those exposed to higher levels of peer victimization more likely to be poor sleepers at baseline. Our findings reveal an important role of peer victimization in predicting transitions in patterns of sleep problems. Intervention programs aimed at decreasing peer victimization may help reduce the development and escalation of sleep problems among adolescents, especially in males.

     

The developmental change in strategies parents employ to settle young children to sleep,and their relationship to infant sleeping problems,as assessed by a new questionnaire: the Parental Interactive Bedtime Behaviour Scale

The development of a new parental self‐report questionnaire, the Parental Interactive Bedtime Behaviour Scale (PIBBS) is described. The PIBBS was designed to capture a wide range of parental behaviours used to settle infants off to sleep. The commonest behaviours employed were giving a feed, talking softly to the child, cuddling in the arms, and stroking. A factor analysis revealed five settling strategies; ‘active physical comforting’ (e.g. cuddling in arms); ‘encouraging infant autonomy’ (e.g. leaving to cry); ‘movement’ (e.g. car rides), ‘passive physical comforting’ (e.g. standing next to the cot without picking the infant up), and ‘social comforting’ (e.g. reading a story). Excessive ‘active physical comforting’ and reduced ‘encourage autonomy’ strategy use was associated with infant sleeping problems. Regarding developmental change in strategy between 1 and 2 years, the later the onset at which ‘encourage autonomy’ became the principal strategy used, the more likely that persistent infant sleeping problems would be present. Factors accounting for the change in strategy use over time were: (i) parental adaptation to infant developmental maturation; (ii) the interaction between maternal cognition and strategy, and, to a lesser extent; (iii) the interaction between infant temperament and parental strategy. Copyright © 2002 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.