Poster group
Details of individual items:
poster
Infants exposed to drugs and alcohol during gestation often exhibitbehavioral disturbances which may include problems in basic functionalareas such as self regulation, feeding and sleeping. Whether suchproblems result from teratogenic effects of these substances of abuse orfrom problems in the postnatal environment remains under discussion.There is evidence that prenatal alcohol and drug exposure affects sleeparchitecture in a persistent manner (Sher et al.,1988) and young infantsexposed to cocaine appear to have difficulties in arousal regulation(Bard, et al, 1999) which may influence later behavior. While clinicalreports suggest exposure to cocaine may lead to difficulties in selfregulation and in sleep, there are few empirical studies of this problemand fewer of the environmental factors which may contribute to it. Thepresent study involved 161 caregiver/infant dyads identified at birthand followed to 24 months. Four groups were recruited: Drug (Full termand Preterm) and Control (Fullterm and Preterm). The subjects werepredominantly African-American, urban, and low SES. Drug use wasascertained via self report (Checklist and ASI) and EMIT urine screensof mothers and infants and included cocaine, alcohol, marijuana, andtobacco. At 24 months, infants' development (Bayley MDI & PDI;growth), behavior (Achenbach Child Behavior Checklist:CBCL), andadaptive routine (feeding, sleeping, self regulation) were assessed aswell as caregiver characteristics and environmental factors. Sleeppatterns were assessed using the T-score from the CBCL (ages 2 and 3)and the Sleep Cluster from the Structured Clinical Interview (SCI;Platzman et al., 1999) both relying on caregiver report.Infants in the Drug groups were reported to have more sleep problems onboth measures (CBCL: F6.68, p<.02; SCI:F17.41, p<.0001) while pretermbirth did not affect sleep. Hierarchical regressions were done toidentify contributing factors which were entered as follows: 1) MaternalResources (psychosocial status; SES), 2) Quality of postnatal caregiving(QC) (Instability, Routine), 3) Ballard scores (term status), 4) OtherDrugs (alcohol, tobacco, and marijuana) and 5) Cocaine. On the CBCLSleep T-Score, only maternal psychosocial status (R23.9, p<.02) and QC(R217.3,p<.001) were significantly related to outcome. On the SCI,these factors (Maternal, R23.2, p<.05; QC, R210.6,p<.001) contributedbut cocaine (R23.5, p<.05), not other drugs, was also significant.Examination of individual items on the SCI Sleep Cluster foundsignificant drug effects on items indicating difficulties in maintainingsleep (e.g.,restlessness, sleeping through the night and increasednightmares) but not in sleep initiation or total sleep time. These results suggest that cocaine exposure and the impairments incaregiving associated with it result in problems in arousal regulationby 24 months, specifically in sleep maintenance. Further research mayilluminate psychophysiological mechanisms for these patterns.
poster
BabySleep was created in order to comprehensively and quantitatively describe the sleep patterns of young infants. BabySleep is a 55-item parent report questionnaire containing 3 types of questions. The first type of question is a columnar time grid ranging from Midnight through 11 PM on which parents indicate when their baby sleeps. Parents complete this first, and can then refer to this schedule as they answer the remaining questions. The second type of question requires a numeric response, for example, 'How many naps does your baby take daily?' The third type requires parents to make a mark on a continuum that best reflects their baby's behavior. For example, for the question 'Baby sleeps about the same amount each day?' parents make a mark on a line with 5 anchors ranging from Never to Always. These responses are quantified by using a centimeter ruler to measure where along the continuum the response falls.To keep BabySleep consistent with a functional perspective and with an existing questionnaire for older infants (Sleep Habits Questionnaire: Seifer et al., 1996), questions focus on sleep habits that affect family life, with categories about current and ideal sleep schedules, background information, bedtime routines, sleep behavior, waking during the night, morning awakening, and parental reactions to baby's sleep patterns. Data from 40 normal 3-month-olds are presented here, but BabySleep may be useful for infants up to 12 months of age.The first issue addressed was whether responses about infants' sleep behaviors fell within established norms for 3-month-old infants. Infants were reported to take 2-3 naps per day, to nap for about 3.5 hours daily, to sleep about 14 hours daily, to go to sleep for the night at about 9PM, to awaken at least once during the night, and to take over 6 min to become alert once awake. Parents reported that their 3-month-old infants rarely fell asleep holding an object, but often fell asleep sucking something. Parents reported occasionally cosleeping with their infants. Parents had tried to modify their infant's behavior a couple of times and had some success with their attempts. These findings are consistent with sleep patterns of young infants.Also addressed was whether responses on BabySleep were related to responses on a temperament questionnaire (Rothbart's IBQ) in predictable ways. Significant correlations were found between struggles at bedtime and IBQ activity level; time spent napping and IBQ Fear (negatively); total number of naps and IBQ Soothability; and parent briefly comforts baby during night and IBQ Smiles.Other significant relations emerged: How many times the parents had tried modifying their infant's sleep pattern was negatively related to the baby's waking up in a positive mood and to how easy they perceived their baby's sleep pattern to be. How easy they perceived their baby's sleep pattern was negatively related to how often their baby awakens crying and the number of times the baby awakens during the night; but was positively related to how much success they felt they had had modifying their baby's sleep pattern.
poster
Professionals. Still, little is known about the significance of individual differences within the normal range of developmental attainments. Two areas that seem to be of particular concern to parents are motor progress and sleep regulation. While the normative sequence of each of these domains has been documented, their relationship has not been a subject of systematic research. In the present study the links between the quality of infants' sleep and their motor achievements are addressed. The specific focus of the investigation is the interrelation between the child's motor progress and changes in the regulation of sleep-wake states around the end of first year. From a broader perspective, the study attempts to examine whether the biological clocks, which govern sleep and motor maturation, are synchronized.Thirty non- risk infants participated in a longitudinal study. This report is based on the 10 and 12 months data: the child's sleep, developmental status (Bayley's Scales, 1993), and walking progress (Jones & Emde, 1987). Sleep measurement included questionnaires completed by mothers and an objective sleep monitor. The sleep recordings were obtained at home, by attaching a small activity monitor to the infant's leg, a method that has been previously validated for measuring infants' sleep. Data included sleep onset, duration, frequency of awakenings, longest uninterrupted sleep segment, and sleep efficiency.Preliminary results point to a link between the infants' motor progress and sleep regulation. The sleep pattern of early walkers tended to be more fragmented compared to late walkers. The significance of upright position and independent locomotion to the developing child will be discussed from bio-behavioral and emotional perspectives. The premise that the maturational changes, which underlie motor transitions, are also manifested in changes in sleep-wake cycles will be examined.
poster
Sleeping difficulties are reported to occur by between 10% and 33% ofparents (depending on age and investigation). These difficulties usuallyinvolve problems of settling at bedtime and/or children waking up at night.The presence of sleeping difficulties is associated with maternaldepression. This study was designed to follow a group of mothers beforethe birth of their child into the pre-school years to examine thecontinuity in sleeping and to try to identify variables associated withsleeping difficulties.Information was collected by questionnaire from 495 mothers who werecontacted before the birth of their children about their attitudes andplans concerning their infant's sleeping. Mothers also answeredquestionnaires at 1 week, 1-, 3-, 5-, 24-, 30-, 36-, 42-, and 48-monthsabout the sleeping patterns of their children, the way the mothersattempted to help their child sleep, and maternal feelings of wellbeing(EPDS and Stress Index). The sample consisted of 195 children at 48 monthsof age.The percentage of children reported to be waking every night of the weekdeclined from 80% at 1-months to 33% at 3 months and thereafter graduallydeclined to 12% at 48-months. There was reasonably high significantcorrelations between the amount of waking at adjacent ages, but as thedistance between ages increased so the correlations became weaker. Takentogether these findings suggest that although some children woke less withincreasing age, other children started waking at an increased incidence.Thus, the population of wakers gradually declined, but the decline was notparticularly steep because new children entered this population.There was predictability between a range of measures and concurrentsleeping or sleeping at adjascent age points. However, none of themeasures in the pre-natal or infant periods had particularly highindividual correlations with later sleeping. Thus, longer term predictionof waking is difficult to make. For example, breast feeding was associatedwith a higher rate of waking during the first 5 months, but was notsignificantly associated with sleeping between 3 and 4 years. Examinationof maternal wellbeing suggesting that these measures may be assessingrelatively stable characteristics of mothers.Thus, the data analysed so far presents a picture of moderate continuitiesin sleeping over the short term, but weaker continuities over the longerterm. Given this picture it is not that surprising that variables measuredin infancy largely failed to predict later sleeping patterns. Theimplications of this for parents and health professionals is discussed.
poster
The nature and development of infant sleep has become an increasing focus of study, spurred by interest in biobehavioral regulatory activity. Still, it is unusual to find empirical work characterizing the interplay of infant sleep behavior and family life, even though there is substantial clinical interest in how infant sleep and sleep problems affect families. We examined 8-month-old infants' sleep, mothers' appraisals of infant sleep, and mothers' symptoms of depression and anxiety. Actigraphs (miniature activity monitors) provide an accurate minute-by-minute account of sleep and wake states (as described by Sadeh and colleagues). Actigraph monitoring was done for at least 5 nights and yielded final measures of mean (per night) number of wake episodes, wake minutes, and sleep efficiency (sleep minutes/[sleep minutes+wake minutes]). Mothers completed a sleep habits questionnaire developed for this study that addressed sleep patterns at 8 months, effect of infant sleep on mother behavior, and expectations for infant sleep in the future. Mothers also completed the Beck Depression and Beck Anxiety scales, each yielding a single symptom score.This report is from a larger longitudinal study in progress, with 46 cases currently available (120 available by July, 2000). Mother reports of overall quality of infant sleep were associated with higher sleep efficiency (r3D.73), and lower number of night wakings (r3D.31) and wake minutes (r3D.66); mother appraisal of overall quality of sleep was not associated with anxiety or depression. Mothers who report more infant night waking had infants whose actigraph measures were lower for sleep efficiency (r3D-.65), and higher for number of wakings (r 3D .38) and wake minutes (r3D.57); mother-reported night waking was not associated with anxiety or depression. Mothers' reports of being tired were associated with lower infant sleep efficiency (r3D-.44) and higher wake minutes (r3D.37); these reports of being tired were related to anxiety (r3D.40) and depression (r3D.32). Mothers' positive expectations for infant sleep were associated with higher sleep efficiency (r3D.37), and lower wake minutes (r3D-.49) and number of wakings (r3D-.36); these expectations were also related to mother anxiety (r3D-.34) but not depression. None of the actigraph measures was related to mother anxiety or depression. Five conclusions: First, children's sleep patterns affect mothers' quality of life. Second, when asked to describe behavior with little interpretation (e.g., in the case of quality of infant sleep), mothers were reasonably accurate reporters, with the reports showing little influence of maternal characteristics such as depression and anxiety. Third, when more interpretation was involved (as in the case of effect on self or future expectations) there remained an association with objectively assessed infant behavior, but mother characteristics of anxiety and depression came into play. Fourth, these mother characteristics of anxiety and depression were not related to the objectively measured patterns of infant sleep. Fifth, anxiety was an important maternal characteristic to consider, having more substantial association with mother appraisals than depression. We interpret these data within a goodness-of-fit model, emphasizing the interplay of infant behavior, maternal characteristics, and mothers' appraisal of that behavior. We also emphasize anxiety as important in understanding parenting appraisals.