Perceived discrimination and youths' adjustment: sleep as a moderator

Adolescents' sleep duration was examined as a moderator of the association between perceived discrimination and internalizing (anxiety, depression) and externalizing symptoms. Participants were 252 adolescents (mean: 15.79 years; 66% European American, 34% African American) who reported on their perceived discrimination (racial and general) and adjustment. Sleep duration was measured using actigraphy. Moderation effects were evident. The lowest levels of internalizing symptoms were observed for adolescents with longer sleep duration in conjunction with lower levels of perceived racial discrimination. Further, general perceived discrimination was associated more strongly with externalizing behaviours for youth with shorter versus longer sleep. Findings highlight the importance of sleep as a bioregulatory system that can ameliorate or exacerbate the effects of discrimination on youths' adjustment.     

Reduced sleep quality in healthy girls at risk for depression

Depression is characterized by sleep difficulties, but the extent to which subjective and objective sleep disturbances precede depression are unclear. This study was designed to examine perceptions of sleep quality in addition to actigraphy‐ and diary‐measured sleep variables in healthy girls at low and high familial risk for major depressive disorder. Forty‐four healthy daughters and their mothers completed a week of daily sleep diary and actigraphy; 24 girls had mothers with no history of psychopathology (low risk, mean age 14.92 years), and 20 girls had mothers with recurrent depression during the daughter’s lifetime (high risk, mean age 14.12 years). All daughters had no current or past psychopathology. High‐risk girls reported significantly poorer subjective sleep quality than did low‐risk girls (P = 0.001). The two groups of participants did not differ in actigraphy‐ or diary‐measured sleep duration, onset latency or snooze duration. Healthy girls at high familial risk for depression report poorer sleep quality than do girls at low risk for depression, despite the absence of group differences in objective sleep disturbances as measured by actigraphy or daily diary. This pattern of findings may reflect a broader cognitive or physiological phenotype of risk for depression.     

Sleep quality,cortisol levels,and behavioral regulation in toddlers

This study examines the association between nighttime sleep characteristics and cortisol levels and how these variables relate to aspects of children's temperament and behavior. Twenty‐seven healthy children, aged 12–36 months, attending group childcare settings, participated in the study. Each child's sleep was measured at home with actigraphy over three nights. Saliva samples were collected by the mothers at bedtime and within 30 min of awakening. In addition, both the mother and the daycare teacher rated the child's behavioral difficulties and negative emotionality. It was found that children with more fragmented sleep displayed higher awakening cortisol levels compared to children with more efficient sleep. Moreover, elevated awakening cortisol levels were correlated with teachers' ratings of internalizing behavior and negative emotionality. These preliminary findings suggest that awakening cortisol may serve as a useful index of adrenocortical reactivity in young children, signaling a disturbance in physiological regulation, and underscore the need for more research pertaining to the dynamic associations between sleep and HPA‐axis across the 24‐hr period. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 52: 44–53, 2010     

Marital Adjustment,Marital Discord Over Childrearing,and Child Behavior Problems: Moderating Effects of Child Age

Examined whether marital discord over childrearing contributes to child behavior problems after taking into account general marital adjustment, and if child age moderates associations between child behavior problems and either general marital adjustment or marital discord over childrearing. Participants were 146 two-parent families seeking services for their child's (4 to 9 years of age) conduct problems. Data on marital functioning and child behavior problems were collected from both parents. Mothers' and fathers' reports of marital discord over childrearing related positively to child externalizing problems after accounting for general marital adjustment. Child age moderated associations between fathers' reports of general marital adjustment and both internalizing and externalizing child problems, with associations being stronger in families with younger children. The discussion highlights the role that developmental factors may play in understanding the link between marital and child behavior problems in clinic-referred families.     

Trajectories of sleep and cardiac sympathetic activity indexed by pre‐ejection period in childhood

Fragmented and insufficient sleep has been implicated in disrupted autonomic nervous system activity during resting state conditions in typically developing children. Towards explication of these relations over development, the current study tested reciprocal relations between the development of sleep parameters (efficiency, duration, latency) and cardiac sympathetic nervous system (SNS) activity indexed by pre‐ejection period (PEP) during waking–resting state conditions throughout middle and late childhood. Whether sleep derives changes in PEP or vice versa was examined. A longitudinal design was employed and latent growth modelling was used to examine the research questions. During the first assessment, 282 children aged 9.44 years (65% European American, 35% African American) participated. Two more assessments followed, with a 1‐year lag between consecutive study waves. Sleep was examined with 7 nights of actigraphy in the child's home. Controlling for many potential confounds (sex, race/ethnicity, body mass index and family socioeconomic status), higher sleep efficiency and more sleep minutes predicted increases in PEP (less SNS activity) over 3 years. PEP did not predict changes in sleep efficiency or duration over time and there were no significant effects for sleep latency. Findings highlight the probable direction of effects between these two key bioregulatory systems. High levels of cardiac SNS activity are associated with many negative health outcomes, and thus these findings may have important implications.     

Children’s sleep,skin conductance level and mental health

We examined relations between children’s sympathetic nervous system activity, indexed by skin conductance level (SCL) during baseline and reactivity to a challenging task and their sleep problems. We also assessed SCL as a moderator of associations between children’s sleep problems and their mental health. A sample of healthy and typically developing school‐attending children (78 boys and 98 girls) participated (mean age = 8.7 years; standard deviation = 0.36). Sleep was assessed via actigraphy and self‐reports. Parents reported on children’s externalizing behaviors and children reported their internalizing symptoms. Findings demonstrate that sleep disruptions (duration, quality) are associated with lower basal SCL. In the context of sleep problems, a lower level of basal SCL functioned as a vulnerability factor for depression symptoms and worse self‐esteem. Further, children with both increased SCL reactivity and sleep problems were at risk for depression symptoms. Results illustrate the significance of simultaneous examinations of various biological and physiological systems in the prediction of children’s wellbeing.     

Relations between daytime pre‐ejection period reactivity and sleep in late childhood

The sympathetic nervous system and children's sleep serve critical arousal regulation functions. Shortened pre‐ejection period, a reliable indirect index of greater sympathetic nervous system activity, has been associated with reduced sleep duration and quality in adults, but limited evidence exists in children regarding associations between pre‐ejection period and sleep. We examined relations between pre‐ejection period reactivity in response to a laboratory‐based stressor and multiple parameters of actigraphy‐based sleep duration and quality in children. The sample included 123 boys and 112 girls [mean age = 11.31 years, standard deviation (SD) = 0.63 years]. Controlling for body mass index, sex and pre‐ejection period baseline, increased sympathetic nervous system reactivity, indexed by a lower level of pre‐ejection period during the challenge than the baseline, was associated with worse sleep quality indicated by lower sleep efficiency, greater sleep activity and greater long wake episodes. The findings add to a small literature on relations between sympathetic nervous system functioning and children's sleep, suggesting that poor sleep quality is related to dysregulation of this stress response system.     

Violence Exposure and Adjustment in Inner-City Youth: Child and Caregiver Emotion Regulation Skill,Caregiver–Child Relationship Quality,and Neighborhood Cohesion as Protective Factor

This short-term, longitudinal interview study used an ecological framework to explore protective factors within the child, the caregiver, the caregiver–child relationship, and the community that might moderate relations between community violence exposure and subsequent internalizing and externalizing adjustment problems and the different patterns of protection they might confer. Participants included 101 pairs of African American female caregivers and one of their children (56% male, M = 11.15 yrs, SD = 1.28) living in high-violence areas of a mid-sized southeastern city. Child emotion regulation skill, felt acceptance from caregiver, observed quality of caregiver–child interaction, and caregiver regulation of emotion each were protective, but the pattern of protection differed across level of the child's ecology and form of adjustment. Implications for prevention are discussed.     

The link between maternal sleep and permissive parenting during late adolescence

Utilizing a multi‐method design, the present study examined the association between maternal sleep, assessed via actigraphy and self‐reports, and permissive parenting (e.g. lax, inconsistent discipline) during adolescence, as well as the extent to which this association differed by mothers’ race/ethnicity and socioeconomic status. The sample was comprised of 234 mothers (M age = 41.76 years, SD = 6.25; 67% European‐American, 31% African‐American, 2% other race/ethnicities) and 237 adolescents (113 boys, 124 girls; M age = 15.80 years, SD = 0.80; 66% European‐American, 34% African‐American). Mothers’ sleep duration (actual sleep minutes) and quality (sleep efficiency, latency, long wake episodes) were assessed using actigraphy. Mothers also reported on their sleep problems and adolescents reported on mothers’ permissive parenting behaviours. Results revealed that actigraphy‐based longer sleep duration and shorter sleep latency were associated with lower levels of permissive parenting. Further, mothers’ race/ethnicity and socioeconomic status moderated the association between actigraphy‐based sleep quality (i.e. sleep efficiency, long wake episodes) and permissive parenting. Specifically, a negative association between sleep efficiency and permissive parenting was evident only for African‐American mothers. In addition, a positive association between more frequent night wakings and permissive parenting was evident only for mothers from lower socioeconomic status households. The findings highlight the benefits of longer and higher‐quality sleep for reducing the risk of permissive parenting, especially among ethnic minority mothers and mothers from lower socioeconomic status households.     

Out of the Picture: A Study of Family Drawings by Children: From Step-, Single-Parent,and Non-Step Families

Investigated the family drawings of 180 children ages 5 to 7 years in various family settings, including stepfather, single-parent, complex stepfamilies, and 2-parent control families. The relations of family type and biological relatedness to omission of family members and grouping of parents were examined. Children from step- and single-parent families were more likely to exclude family members than children from "control" non-step families, and exclusion was predicted from biological relatedness. Children who were biologically related to both resident parents were also more likely to group their parents together. Omission of family members was found to be associated with children's adjustment (specifically more externalizing and internalizing behavior) as reported by teachers and parents. The results indicate that biological relatedness is a salient aspect of very young children's representations of their families. The association between adjustment and exclusion of family members and grouping of parents indicates that family drawings may be useful research and clinical tools, when used in combination with other methods of assessment.     

No objectively measured sleep disturbances in children with attention‐deficit/hyperactivity disorder

The main goal of this study was to gain more insight into sleep disturbances in children with attention‐deficit/hyperactivity disorder, using objective measures of sleep quality and quantity. The evidence for sleep problems in children with attention‐deficit/hyperactivity disorder thus far is inconsistent, which might be explained by confounding influences of comorbid internalizing and externalizing problems and low socio‐economic status. We therefore investigated the mediating and moderating role of these factors in the association between attention‐deficit/hyperactivity disorder and sleep problems. To control for the effects of stimulant medication use, all participants were tested free of medication. Sixty‐three children with attention‐deficit/hyperactivity disorder and 61 typically developing children, aged 6–13 years, participated. Sleep was monitored for one to three school nights using actigraphy. Parent and teacher questionnaires assessed symptoms of attention‐deficit/hyperactivity disorder, internalizing behaviour, oppositional defiant disorder and conduct disorder. Results showed no differences between the attention‐deficit/hyperactivity disorder and typically developing group in any sleep parameter. Within the attention‐deficit/hyperactivity disorder group, severity of attention‐deficit/hyperactivity disorder symptoms was not related to sleep quality or quantity. Moderation analyses in the attention‐deficit/hyperactivity disorder group showed an interaction effect between attention‐deficit/hyperactivity disorder symptoms and internalizing and externalizing behaviour on total sleep time, time in bed and average sleep bout duration. The results of our study suggest that having attention‐deficit/hyperactivity disorder is not a risk factor for sleep problems. Internalizing and externalizing behaviour moderate the association between attention‐deficit/hyperactivity disorder and sleep, indicating a complex interplay between psychiatric symptoms and sleep.     

Exercise and sleep in community‐dwelling older adults: evidence for a reciprocal relationship

Exercise behaviour and sleep are both important health indicators that demonstrate significant decreases with age, and remain modifiable well into later life. The current investigation examined both the chronic and acute relationships between exercise behaviour and self‐reported sleep in older adults through a secondary analysis of a clinical trial of a lifestyle intervention. Seventy‐nine community‐dwelling, initially sedentary, older adults (mean age = 63.58 years, SD = 8.66 years) completed daily home‐based assessments of exercise behaviour and sleep using daily diary methodology. Assessments were collected weekly and continued for 18 consecutive weeks. Multilevel models revealed a small positive chronic (between‐person mean‐level) association between exercise and wake time after sleep onset, and a small positive acute (within‐person, day‐to‐day) association between exercise and general sleep quality rating. The within‐person exercise and general sleep quality rating relationship was found to be reciprocal (i.e. sleep quality also predicted subsequent exercise behaviour). As such, it appears exercise and sleep are dynamically related in older adults. Efforts to intervene on either sleep or exercise in late‐life would be wise to take the other into account. Light exposure, temperature regulation and mood may be potential mechanisms of action through which exercise can impact sleep in older adults.     

Family Stability as a Protective Factor Against Psychopathology for Urban Children Receiving Psychological Services

Family stability, defined as the consistency of family activities and routines, was examined in a sample of urban families (n = 70) with children (ages 7 to 16) receiving psychological services. Parent-reported family stability was associated with lower parent-reported children's internalizing behavior problems. Child-reported family stability significantly attenuated the influence of parental depressive symptoms on parent-reported children's internalizing, externalizing, and total behavior problems, while controlling for the effect of children's age. Parental depressive symptoms were associated with problems in child adjustment only at the low level of family stability.     

A Nightly Bedtime Routine: Impact on Sleep in Young Children and Maternal Mood

Background:

Establishment of a consistent bedtime routine is often recommended to parents of young children, especially those with sleep difficulties. However, no studies have investigated the efficacy of such a routine independent of behavioral intervention. Thus, the purpose of this study was to examine the impact of a consistent bedtime routine on infant and toddler sleep, as well as maternal mood.

Methods:

405 mothers and their infant or toddler (ages 7-18 months, n = 206; ages 18-36 months, n = 199) participated in 2 age-specific 3-week studies. Families were randomly assigned to a routine or control group. The first week of the study served as a baseline during which the mothers were instructed to follow their child''s usual bedtime routine. In the second and third weeks, mothers in the routine group were instructed to conduct a specific bedtime routine, while the control group continued their child''s usual routine. All mothers completed the Brief Infant Sleep Questionnaire (BISQ) on a weekly basis and a daily sleep diary, as well as completed the Profile of Mood States (POMS).

Results:

The bedtime routine resulted in significant reductions in problematic sleep behaviors for infants and toddlers. Significant improvements were seen in latency to sleep onset and in number/duration of night wakings, P < 0.001. Sleep continuity increased and there was a significant decrease in the number of mothers who rated their child''s sleep as problematic. Maternal mood state also significantly improved. Control group sleep patterns and maternal mood did not significantly change over the 3-week study period.

Conclusion:

These results suggest that instituting a consistent nightly bedtime routine, in and of itself, is beneficial in improving multiple aspects of infant and toddler sleep, especially wakefulness after sleep onset and sleep continuity, as well as maternal mood.

Citation:

Mindell JA; Telofski LS; Wiegand B; Kurtz ES. A nightly bedtime routine: impact on sleep in young children and maternal mood. SLEEP 2009;32(5):599–606.     

Internight sleep variability: its clinical significance and responsiveness to treatment in primary and comorbid insomnia

Although sleep diary and actigraphy data are usually collected daily for 1 or 2 weeks, traditional analytical approaches aggregate these data into mean values. Internight variability of sleep often accompanies insomnia. However, few studies have explored the relevance of this ‘construct’ in the context of diagnosis, clinical impact, treatment effects and/or whether having ‘variable sleep’ carries any prognostic significance. We explored these questions by conducting secondary analyses of data from a randomized clinical trial. The sample included primary (PI: n = 40) and comorbid insomnia (CMI: n = 41) sufferers receiving four biweekly sessions of cognitive–behavioural therapy (CBT) or sleep hygiene education. Using the within‐subject standard deviations of diary‐ and actigraphy‐derived measures collected for 2‐week periods [sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST) and sleep efficiency (SE)], we found that CMI sufferers displayed more variable self‐reported SOLs and SEs than PI sufferers. However, higher variability in diary and actigraphy‐derived measures was related to poorer sleep quality only within the PI group, as measured by the Pittsburgh Sleep Quality Index (PSQI). Within both groups, the variability of diary‐derived measures was reduced after CBT, but the variability of actigraphy‐derived measures remained unchanged. Interestingly, the variability of actigraphy measures at baseline was correlated with PSQI scores at 6‐month follow‐up. Higher SOL variability was associated with worse treatment outcomes within the PI group, whereas higher WASO variability was correlated with better treatment outcomes within the CMI group. Sleep variability differences across insomnia diagnoses, along with their distinctive correlates, suggest that mechanisms underlying the sleep disruption/complaint and treatment response in both patient groups are distinct. Further studies are warranted to support variability as a useful metric in insomnia studies.     

Relations of Parenting to Adolescent Externalizing and Internalizing Distress Moderated by Perception of Neighborhood Danger

Parental monitoring and warmth have traditionally been studied in the context of White, middle-class families. This article explores optimal levels of these parenting behaviors in preventing adolescent psychopathology in impoverished, urban high-crime areas while accounting for child perceptions of neighborhood danger. In this study, data were collected longitudinally at 2 time points 1 year apart from a sample of 254 African American young adolescents (T1: M age = 12.6 years, 41% male) and their parents. Parental monitoring and warmth, child perception of neighborhood danger, and child internalizing and externalizing behaviors were measured using questionnaires. Child internalizing behaviors were also measured using a time sampling technique capturing in vivo accounts of daily distress. Findings indicated associations between parental monitoring and children's externalizing behaviors along with linear and quadratic associations between parental monitoring and internalizing behaviors. Monitoring and warmth were differentially related to symptoms depending on neighborhood danger level. When children perceived less danger, more monitoring related to less externalizing. When children perceived more danger, more warmth related to less internalizing. In addition, adolescents' perceptions of neighborhood danger emerged as equally strong as monitoring and warmth in predicting symptoms. This study underscores the influence of carefully considering parenting approaches and which techniques optimally prevent adolescents' externalizing, as well as prevent internalizing difficulties. It also highlights how context affects mental health, specifically how perceptions of danger negatively influence adolescents' psychopathology, emphasizing the importance of initiatives to reduce violence in communities.     

Daily antecedents and consequences of nightly sleep

Sleep can serve as both cause and consequence of individuals’ everyday experiences. We built upon prior studies of the correlates of sleep, which have relied primarily on cross‐sectional data, to examine the antecedents and consequences of sleep using a daily diary design. Specifically, we assessed the temporal sequence between nightly sleep and daily psychosocial stressors. Parents employed in a US information technology company (n = 102) completed eight consecutive daily diaries at both baseline and 1 year later. In telephone interviews each evening, participants reported on the previous night's sleep hours, sleep quality and sleep latency. They also reported daily work‐to‐family conflict and time inadequacy (i.e. perceptions of not having enough time) for their child and for themselves to engage in exercise. Multi‐level models testing lagged and non‐lagged effects simultaneously revealed that sleep hours and sleep quality were associated with next‐day consequences of work‐to‐family conflict and time inadequacy, whereas psychosocial stressors as antecedents did not predict sleep hours or quality that night. For sleep latency, the opposite temporal order emerged: on days with more work‐to‐family conflict or time inadequacy for child and self than usual, participants reported longer sleep latencies than usual. An exception to this otherwise consistent pattern was that time inadequacy for child also preceded shorter sleep hours and poorer sleep quality that night. The results highlight the utility of a daily diary design for capturing the temporal sequences linking sleep and psychosocial stressors.     

Comparison of actigraphy with polysomnography and sleep logs in depressed insomniacs

Actigraphy is increasingly used in the assessment and treatment of various clinical conditions, being a convenient and cost‐effective method of capturing bodily movements over long periods of time. This study examined the use of actigraphy in the measurement of sleep of patients with depression and insomnia. Fifty‐four patients diagnosed with a current major depressive episode and chronic insomnia underwent a baseline overnight study with concurrent actigraphic and polysomnography (PSG) monitoring, as well as subjective sleep diaries. Agreement between PSG, actigraphy and sleep diary measurements was evaluated using two‐tailed t‐tests, Pearson’s correlations and the Bland–Altman concordance technique. The only significant difference found between actigraphy and PSG was in latency to persistent sleep, in which actigraphy underestimated sleep latency relative to PSG (P < 0.05). There were moderate positive correlations between actigraphy and PSG for all variables. In contrast, significant differences were observed between sleep diaries and PSG for all sleep variables. Bland–Altman concordance diagrams also demonstrated that, while bias was limited between PSG and the other two measurement types, there were somewhat broad 95% limits of agreement for all sleep variables with both sleep diaries and actigraphy. In summary, actigraphic measurements of sleep more closely approximated those of PSG than did sleep diaries in this sample of depressed insomniacs.     

Children's experience of life stress: The role of family social support and social problem-solving skills as protective factors

Examined the role of family social support and social problem-solving skills in moderating the effects of children's stressful life events on behavioral adjustment. Participants were 322 fourth and fifth graders who reported on their stressful experiences during the past year. Children from both regular education (RE) or special education (SE) classrooms were included in the sample. Additional self-report data from children also included measures related to perceived level of family social support, a personality questionnaire, and a social problem-solving measure. In addition, teachers provided reports of the children's behavior and adjustment. Main effects were found for total stress, school/peer stress, family social support, and social problem solving. Significant moderator effects were found for family support on total stress for the teacher-reported internalizing problems of RE students and for family support on school/peer stress on the teacher-reported externalizing problems and self-reported anxiety problems of SE students. Specific, theory-generated hypotheses are discussed as a more effective method of examining relations between stress and various moderator variables.     

Discrepancies in sleep diary and actigraphy assessments in adults with fibromyalgia: Associations with opioid dose and age

Sleep diary and actigraphy assessments of insomnia symptoms in patients with fibromyalgia (FM) are often discrepant. We examined whether opioid dose and age interact in predicting magnitude or direction of discrepancies. Participants (N = 199, M = 51.5 years, SD = 11.7) with FM and insomnia completed 14 days of diaries and actigraphy. Multiple regressions determined whether average opioid dose and its interaction with age predicted magnitude or direction of diary/actigraphy discrepancies in sleep onset latency (SOL), wake after sleep onset (WASO) and sleep efficiency (SE), controlling for sex, use of sleep medication, evening pain and total sleep time. Higher opioid dose predicted greater magnitude of discrepancy in SOL and SE. Opioid dose interacted with age to predict direction but not magnitude of discrepancy in SOL and SE. Specifically, higher opioid use was associated with better subjective (shorter SOL, higher SE) than objective reports of sleep among younger adults, and longer subjective than objectively measured SOL among older adults. Opioid dose did not predict magnitude or direction of WASO discrepancies. In FM, a higher opioid dose increases diary/actigraphy SOL and SE discrepancies, and direction of discrepancies may depend on age. We speculate that increased opioid use combined with age‐related factors, such as slow wave sleep disruption, increased awakenings and/or cognitive decline, may impact perceived sleep.