Controversies in Behavioral Treatment of Sleep Problems in Young Children

Early life adversity and adolescent sleep problems during the COVID-19 pandemic

The COVID-19 pandemic resulted in a reorganization of adolescents' routines, especially their sleep schedules. Utilising 175 caregiver-adolescent dyads, the current study examined associations of biological (e.g., prenatal substance use), environmental (e.g., poverty), and relational (e.g., child maltreatment) subtypes of early life adversity (ELA) with various components of adolescents' sleep across the first year of the COVID-19 pandemic. Relational ELA explained unique variance in adolescents' sleep disturbances, but not other sleep components, following short- and longer-term exposure to the COVID-19 pandemic. However, the direction of this association switched such that relational ELA predicted decreased sleep disturbances during the initial phase of the U.S. COVID-19 pandemic in spring 2020 beyond pre-pandemic levels, but, over time, contributed to increased sleep disturbances beyond early-pandemic levels as the pandemic extended into the winter of 2020.

Exploring role of sleep aids in sleep problems in preschool children

It is well known that children use sleep aids, such as blankets or soft toys, at bedtime. However, there is a lack of understanding regarding the factors associated with their use and role in addressing sleep problems. This study investigated 96 Japanese children aged 40 to 47 months to examine these associations. We measured children's stress (through a questionnaire and salivary cortisol [cortisol awakening response]), anxiety symptoms, behavioral problems, and temperament, and created a model to predict the status of sleep aid use. Furthermore, we explored the association between sleep aid use and children's sleep problems as evaluated by their caregivers. We found that children who used sleep aids were more likely to experience anxiety symptoms. Moreover, most children used sleep aids even when they co-slept with their caregivers and/or siblings. Their use was not uniquely associated with sleep problems. These findings suggest that sleep aid serves as a defense against anxiety, including that caused by the absence of a caregiver, rather than as a substitute for a caregiver. Our study sheds light on their role and emphasizes the importance of viewing development within the complex interactive processes of humans and objects.

Association between sleep habits and behavioral problems in early adolescence: a descriptive study

Background

Sleep habits are related to children's behavior, emotions, and cognitive functioning. A strong relationship exists between sleep habits and behavioral problems. However, precisely which sleep habits are associated with behavioral problems remains unclear. Therefore, the purpose of this study is to clarify the relationship between sleep habits and behavioral problems in early adolescence.

Methods

This study used data from a larger longitudinal research, specifically, data from the year 2021. First-year junior high school students (12–14 years) in Japan were surveyed; their parents (N = 1288) completed a parent-report questionnaire. The main survey items were subject attributes, the Pittsburgh Sleep Quality Index (PSQI), and the Strength and Difficulties Questionnaire (SDQ).

Results

Of the 652 valid responses received, 604 individuals who met the eligibility criteria (no developmental disability in the child and completion of all survey items) were included in the analysis. To examine the relationship between sleep habits and behavioral problems, logistic regression analysis using the inverse weighted method with propensity score was conducted with sleep habits (sleep quality, time to fall asleep, sleep duration, sleep efficiency, sleep difficulty, use of sleeping pills, difficulty waking during the day, and sleep disturbances) as explanatory variables and behavioral problems (overall difficulty in SDQ) as objective variables. The propensity score was calculated by employing the logistic regression using the inverse weighted method based on propensity scores. Propensity scores were calculated based on gender, family structure, household income, and parental educational background. The results showed that behavioral problems tended to be significantly higher in the group at risk for sleep quality, sleep difficulties, daytime arousal difficulties, and sleep disturbances than in the group with no risk.

Conclusion

The results suggest that deterioration in sleep quality, sleep difficulties, daytime arousal difficulties, and sleep disturbances may increase the risk of behavioral problems in adolescents.

Parental Use of "Cry Out" in a Community Sample During the First Year of Infant Life

OBJECTIVE

The primary objective was to identify the characteristics of parents and infants and parenting practices associated with delayed responsiveness to infant crying during the first year of infant life. A secondary objective was to evaluate, in a subsample of maternal-infant pairs, the associations between delayed responsiveness to infant crying and observational measures of maternal-infant interaction and infant-maternal attachment.

METHOD

This is a secondary analysis of the data from a community sample of pregnant women recruited to the Alberta Pregnancy Outcomes and Nutrition study. Mothers completed questionnaires during the first year of infant life (n = 1826), and a convenience subsample of maternal-infant pairs (n = 137) participated in laboratory assessments of maternal-infant interaction at 6 months of age and infant-maternal attachment at 20 months.

RESULTS

Parental use of "cry out" as a strategy to deal with a crying infant was associated with parental characteristics (being white and having a relatively higher income), infant characteristics (higher problematic behavior at 3 months and reduced problematic behavior at 12 months), sleep ecology (infants sleeping alone), and parental soothing strategies (less frequently taking the infant into the parent's bed, cuddling, or carrying the crying infant). Cry out was not associated with observational measures of maternal sensitivity or infant-maternal attachment.

CONCLUSION

When used selectively and in response to the specific needs and characteristics of the infant, delayed responsiveness may reduce problematic behavior and does not harm the infant's socioemotional development.

Tratamento multicomponente para insônia infantil e seus efeitos nos padrões, hábitos e rotinas de sono

Problemas de sono são frequentes na infância e estão associados a problemas de comportamento. O estabelecimento de rotinas pré-sono é recomendado para pais de crianças. Nenhum estudo brasileiro investigou os hábitos e rotinas de crianças que apresentam problemas de sono. Os objetivos deste estudo foram investigar os hábitos e rotinas de crianças com problemas de sono e verificar se a educação parental sobre o sono da criança levou a mudanças nos padrões de sono e de rotina. Participaram 57 crianças com problemas comportamentais relacionados ao sono e suas mães. As mães receberam orientações sobre o sono das crianças e estabelecimento de rotinas pré-sono. Os dados foram avaliados através de medidas parentais. Nossos resultados apontaram que crianças com problemas de sono apresentam em sua maioria, hábitos e rotinas inadequadas antes de dormir e que a modificação destes levam a melhora do sono. Espera-se que este trabalho possa estimular a produção de pesquisas nacionais sobre o tema, servindo como incentivo para o desenvolvimento de medidas preventivas e interventivas para os problemas de sono na infância.

Behavioral intervention for sleep problems in childhood: a Brazilian randomized controlled trial

Background

Sleep problems are common in children and can have an effect on behavioral and emotional functioning. Despite the importance of sleep for children’s health, there is a lack of studies on this topic in Brazil. The aim of this study was to evaluate the efficacy of behavioral intervention for sleep problems in young children and to investigate the effects on their daytime behavior.

Methods

Sixty-two children (ages 1–5; M = 2.3, SD = 1.3) with bedtime problems and night waking were randomized to a parent-based intervention or a wait list control group. After the waiting period, the wait list participants were offered treatment. The intervention was composed of five sessions over 2 months, during which the parents were educated on their child’s sleep and received guidance on the establishment of sleeping schedules and routines and on the use of extinction and positive reinforcement techniques. Sleep patterns and behavior problems were assessed with parent-report measures. Sleep patterns were also assessed with actigraphy. Assessments were completed at pre-intervention, post-intervention, 1-month follow-up, and 6-month follow-up.

Results

Children who received intervention showed greater baseline to post-treatment improvements in sleep latency, night waking, behavior such as resisting going to bed, the desire to sleep with their parents, and daytime behavior than the control group. These improvements were maintained at follow-up.

Conclusions

We concluded that behavioral parent-based intervention is effective in improving the quality of sleep and the diurnal behavior of children. This study provides initial support for use of this protocol in psychology clinics/schools. Brazilian clinical trials registration, RBR-4kxxd5. Retrospectively registered on December 13, 2016.

Orientação Parental para Insônia Infantil em Irmãos Gêmeos: Um Relato de Caso

Resumo A intervenção comportamental, por meio da orientação parental, vem alcançando resultados positivos no manejo da insônia em crianças. Contudo, questiona-se a efetividade de tais intervenções em irmãos gêmeos, pelo fato de os pais partilharem os cuidados de duas crianças da mesma idade e nível de desenvolvimento. O objetivo deste estudo é apresentar um relato de caso de intervenção comportamental para insônia infantil em irmãos gêmeos por meio de um programa dirigido aos pais e verificar o efeito da intervenção no sono e comportamentos diurnos das crianças. A mãe dos gêmeos foi orientada quanto as técnicas de extinção e reforço positivo no manejo do problema de sono infantil. Os resultados demonstraram que depois da intervenção houve melhora nos hábitos de sono, na qualidade do sono e nos comportamentos internalizantes e externalizantes das crianças. Os achados apresentados neste estudo mostraram os efeitos positivos que a intervenção baseada na aprendizagem operante teve sobre o sono e o comportamento infantil. Este aspecto ressalta a importância de uma inserção maior da questão do sono na Psicologia, a partir de práticas preventivas e interventivas.