Portrait of sleep in preschoolers involved with Child Protective Services and from the community.

OBJECTIVES: The objectives of this exploratory study were: 1) to draw a portrait of sleep, using actigraphic sleep measures, sleep diaries and a validated sleep questionnaire in preschoolers (3- to 5-year-olds) involved with Child Protective Services (CPS) and to compare it with preschoolers from the community, not involved with CPS and 2) to verify whether the sleep differences between the two groups persisted after adjusting for covariates (sociodemographic and child characteristics). METHODS: A total of 92 preschoolers aged from 3 to 5 years (49,5 ± 7,0 months) participated in the study (n = 22 preschoolers involved with CPS and n = 70 preschoolers from the community). Actigraphic sleep parameters were recorded using the child's non-dominant wrist over 72 h during weekdays and sleep diaries were filled out by parents (for nighttime) and childcare specialists (for daytime). Parents filled out the Child Sleep Habits Questionnaires (CSHQ) to measure their perception of their child's sleep. Chi-square tests, ANOVAs, and linear regressions were used to analyze the data and adjust for covariates (sociodemographic and child characteristics). RESULTS: Preschoolers involved with CPS took longer to fall asleep and signaled significantly fewer nighttime awakenings to their parents compared to the group of preschoolers from the community. These significant effects were still present after adjusting for covariates (sociodemographic and child characteristics). CONCLUSIONS: Understanding the underpinnings of these sleep differences by exploring their possible links with daytime cortisol production, sleep ecology and parent-child attachment are interesting avenues for future research.

Meta-analyses of the associations of mentalization and proxy variables with anxiety and internalizing problems.

Mentalization, the high-order function of detecting and interpreting one's own and others' mental states, has gained interest in the fields of clinical and developmental psychopathology. However, little is known about mentalization's associations with anxiety and broader internalizing problems. Using the framework of the multidimensional model of mentalization, the aim of this meta-analysis was to quantify the strength of the association between mentalization and anxiety/internalizing problems and to identify potential moderators of this association. A systematic review of the literature led to the inclusion of 105 studies (N = 19,529) covering all age groups. The global effect analysis showed a small negative association between mentalization and the overall anxious and internalizing symptomatology (r = -0.095, p = .000). Various effect sizes were found for associations between mentalization and specific outcomes (unspecified anxiety, social anxiety, generalized anxiety, and internalizing problems). The methods of assessment of mentalization and anxiety moderated their association. Findings support the presence of modest impairments in the mentalizing capacities of anxious individuals, likely influenced by their vulnerability to stress and the context in which they mentalize. Further studies are needed to draw a clear profile of mentalizing capacities with regard to specific anxious and internalizing symptomatologies.

Sleep ecology, objective sleep characteristics and behavior problems in preschoolers referred to child protection services: An exploratory study.

BACKGROUND: Exposure to environmental risk factors increases the negative impact maltreatment has on children's development. Sleep ecology (i.e., sleep hygiene and home sleeping conditions) can be one of these factors. Poor sleep hygiene and suboptimal home sleeping conditions can alter sleep characteristics, which in turn, may lead to behavior problems (BPs), highly prevalent in maltreated preschoolers. OBJECTIVES: Describe sleep ecology in maltreated preschoolers and explore associations between their sleep ecology, objective sleep characteristics and BPs. METHOD: Parents (n = 22) completed the Children's Sleep Hygiene Scale (CSHS), and a sleep environment questionnaire to document sleep ecology. Children wore an actigraph to record objective sleep characteristics. Parents completed the Behavioral Assessment Scale for Children (BASC-2) to assess children's BPs. Descriptive and correlational analyses were performed. RESULTS: Most of the parents (90.5 %) reported adequate sleep hygiene. However, 20 parents (95.2 %) reported suboptimal home sleeping conditions. Better physiological and overall sleep hygiene were related to earlier sleep onset. Better emotional sleep hygiene was associated with shorter nighttime awakenings and better sleep efficiency. Later sleep onset was associated with lower anxiety, and longer 24-hour sleep duration with higher somatization. Better physiological sleep hygiene was associated with less depression, and better emotional sleep hygiene with less hyperactivity. CONCLUSION: This study showed that sleep hygiene could be associated with maltreated preschoolers' sleep characteristics and BPs, and that their home sleeping conditions may be of concern. Associations between sleep ecology, objective sleep characteristics and BPs deserve to be better understood, and further explored.

Reflective Functioning in Children and Adolescents With and Without an Anxiety Disorder.

Reflective functioning (RF), meaning the capacity to interpret mental states (intentions, emotions, thoughts, desires, and beliefs) underlying one's own and others' behaviors, may help understand the dysfunctional self-regulation associated with anxiety disorders. However, research on anxiety and RF in clinical samples is scarce. This study aimed to assess whether mothers' and youths' RF was associated with youths' (a) anxiety disorders and symptoms and (b) internalizing symptoms. Another goal was to explore whether RF predicted anxiety and internalizing symptoms beyond the more commonly established effect of attachment. Canadian children and adolescents aged between 8 and 16years, and their mothers were recruited in an outpatient psychiatric clinic (clinical group with a diagnosed anxiety disorder, n=30, mean age=11.5±2.8years) and in the general population (non-clinical group, n=23, mean age=11.5±2.1years). The Child Attachment Interview was used to assess youths' attachment along with three dimensions of RF (global, regarding self, regarding others). Mothers' attachment and RF were assessed with the Adult Attachment Interview. Children's and adolescents' anxiety and internalizing symptoms were measured with the Behavior Assessment Scale for Children, second version. The clinical and non-clinical groups did not differ in mothers' or youths' RF. However, in the overall sample, youths' RF regarding themselves and maternal attachment preoccupation were associated with internalizing symptoms. Sequential regression analyses revealed that higher RF regarding self predicted a higher level of self-reported internalizing symptoms, beyond the effect of maternal attachment (ß=0.43, p<0.05). This study's finding suggests that clinically anxious children and adolescents have adequate RF. We propose that the sustained hypervigilance and apprehension associated with anxiety make anxious youths sensitive to their own and others' mental states. Our findings suggest that psychotherapeutic treatments for anxiety should make use of patients' RF abilities to help them make sense of their symptoms and thus reduce them.

Sleep ecology, sleep characteristics and behavior problems in young maltreated children: A scoping review.

BACKGROUND: Behavior problems are highly prevalent in young maltreated children. Their etiology is multifactorial and has been widely documented. Lately, researchers paid increased attention to the role of sleep in non-maltreated children's behavior problems. They showed that poor sleep (e.g., short sleep duration, nocturnal awakenings) increased behavior problems. In addition, an inadequate sleep ecology (e.g., lack of sleep hygiene or bedtime routine) may lead to sleep problems. OBJECTIVE: As maltreated children often live in disorganized environments, this study aims to map knowledge about sleep ecology and sleep characteristics, as well as their associations with behavior problems in young maltreated children from one to five years old. METHOD: A scoping review was performed according to the PRISMA-SR checklist. Bibliographic databases were searched from 1993 to May 2020. RESULTS: From the 650 studies screened, nine reported results about sleep ecology or sleep characteristics or their associations with behavior problems in young maltreated children. Only one study described their sleep ecology. Eight studies documented or compared sleep characteristics, showing slight differences between maltreated and non-maltreated children (e.g., longer nighttime sleep duration or shorter naps in maltreated children). Four studies revealed associations between sleep characteristics and behavior problems in young maltreated children (e.g., shorter sleep duration was associated with more externalizing behaviors). CONCLUSION: Literature about sleep ecology, sleep characteristics, as well as with their associations with behavior problems in young maltreated children is scarce. Their sleep ecology especially deserves to be investigated. Longitudinal studies, studies with comparison groups, combining objective and subjective validated sleep measures, and taking into account maltreatment characteristics and children's developmental stage should be pursued.

Maternal lack of sleep in the first two years after childbirth: Perceived impacts and help-seeking behaviors.

Most evidence-based sleep interventions (e.g., graduated extinction of nighttime crying) are in opposition to many parents' values. This warrants taking a step back and asking the parents about their main concerns regarding their baby's sleep and the type of help they would be likely to use. This study aimed to describe and identify, among mothers of a 0- to 24-month-old child, the perceived impact of lack of sleep, sleep-related help-seeking behaviors as well as the most concerning aspects of the child's sleep, and preferred sleep intervention modalities. Another objective was to identify the factors associated with a negative impact of postpartum sleep, concerns for the child's sleep, and interest in sleep interventions. Canadian mothers (N = 932) were recruited by email snowball sampling and through Facebook to complete an online questionnaire designed for the purposes of the study. Most mothers reported a negative impact of postpartum sleep on their romantic relationship (79.4%) and quality of life (76.7%). Low parental self-efficacy (PSE) about managing the child's sleep was the best predictor of a negative impact of lack of sleep and sleep-related concerns, above and beyond any other child's or mother's characteristics. The preferred intervention modalities were reliable websites and online courses on child sleep, with a greater interest in home visits among mothers who need help the most (low self-efficacy, high concerns). Interventions should aim at increasing PSE about the child's sleep in both parents and include home visits for those who need it the most.

Muchas intervenciones sobre el dormir con base en la evidencia (v.g. la extinción gradual del llanto en la noche) solicitan un débil cumplimiento por parte de los padres. Esto amerita un paso atrás para investigar las principales preocupaciones de los padres acerca del sueño de sus bebés y el tipo de ayuda que ellos prefieren. Este estudio se propuso describir, entre madres de niños de 0 a 24 meses de nacidos, la percepción del impacto de la falta de sueño, los aspectos más preocupantes del sueño del infante, así como las preferidas modalidades de intervención. Otro objetico fue identificar los factores asociados con estos principales resultados del estudio. Se reclutaron madres canadienses (N = 932) a través de Facebook para completar un cuestionario en forma electrónica diseñado para este estudio. La mayoría de las madres reportaron un impacto negativo del sueño posterior al parto sobre sus relaciones románticas (79.4%) y sobre la calidad de vida (76.7%). La baja autoeficacia de la madre acerca de cómo manejar el sueño del niño resultó ser el mejor factor de predicción de un impacto negativo de la falta de sueño y de las preocupaciones relacionadas con el sueño, más allá de cualquier otra característica del niño o de la madre. Las modalidades de intervención preferidas fueron los confiables sitios en la internet y cursos por computadora acerca del sueño del infante, con un mayor interés en visitas a casa entre las madres que necesitan más ayuda (baja autoeficacia, alto número de preocupaciones). Las intervenciones deben proponerse aumentar la autoeficacia de las madres con respecto al sueño e incluir visitas a casa para aquellas que las necesitan más.

Bien des interventions de sommeil factuelles (par exemple la disparition graduée des pleurs la nuit) produit peu de suivi de la part des parents. Cela mérite de se poser afin d'investiguer les inquiétudes principales des parents concernant le sommeil de leur bébé et le type d'aide qu'ils préféreraient. Cette étude s'est donné pour but de décrire, parmi les mères d'un enfant de 0 à 24 mois, l'impact perçu du manque de sommeil, les aspects les plus inquiétants du sommeil de l'enfant, et les modalités d'intervention préférées. Un autre objectif était d'identifier les facteurs liés à ces principaux résultats de l'étude. Des mères canadiennes (N = 932) ont été recrutées au travers de Facebook afin de remplir un questionnaire en ligne développé pour cette étude. La plupart des mères ont fait état d'un impact négatif du sommeil postpartum sur leur relation romantique (79,4%) et leur qualité de vie (76,7%). Une auto-efficacité parentale peu élevée pour ce qui concerne la gestion du sommeil de l'enfant était le meilleur prédicteur d'un impact négatif du manque de sommeil et de soucis liés au sommeil, au-delà de toutes caractéristiques de la mère et de l'enfant. Les modalités d'intervention préférées étaient des sites internet fiables et des cours en ligne sur le sommeil de l'enfant, avec un plus grand intérêt pour des visites à domicile chez les mères qui en avaient le plus besoin (auto-efficacité peu élevée, grandes inquiétudes). Les interventions devraient se donner pour but d'augmenter l'auto-efficacité parentale liée au sommeil et inclure des visites à domicile pour ceux qui en ont le plus besoin.

Attachment assessment in clinical practice: Factor structure of the attachment questionnaire.

OBJECTIVE: Attachment theory is of great relevance to psychotherapy process and outcome. The labor-intensive and time-consuming nature of attachment codification impedes its widespread use in clinical practice. The Attachment Questionnaire (AQ), a clinician-rated instrument, was developed to address these limitations. However, the status of validation of the AQ remains preliminary. The objective of this study is to further validate the AQ by evaluating its factor structure and convergent validity. METHODS: To this end, 389 psychotherapists completed the AQ and assessed patients' personality disorders and level of functioning. RESULTS: Factor analyses revealed that a five-factor solution provided a better fit than the original four-factor solution. The additional factor, inhibited exploration, captured difficulties in open, nondefensive, exploration of memories and their effects. Correlations between AQ factors and criterion variables support the convergent validity of the AQ. CONCLUSIONS: These results are discussed in light of patients' characteristics and recent advances in attachment research.

Countertransference and Psychological Assessment: Direct and Indirect Exposure.

Countertransference (CT) is usually conceptualized as emerging in the course of psychotherapy. This study explores whether CT manifests itself in the context of assessment and if the modality of exposure to participants (interviewer and observer) affects the intensity and nature of CT. Evaluators either led (direct exposure) or observed (indirect exposure) a 6-hour interview with a subject focusing on attachment and personality. Interviewers and evaluators then completed a measure of CT, the Therapist Response Questionnaire for a total of 43 subjects. Results show significant CT reactions for both interviewers and observers that were globally as intense in both conditions, although lower positive/satisfying and helpless/inadequate CTs were reported by observers. Moreover, intraclass correlations suggest that interviewers' and observers' CT reactions toward the same interviewee show an important degree of similarity. These results highlight the presence of CT in assessment contexts and support the existence of an objective part to CT reactions.

Sleeping Toward Behavioral Regulation: Relations Between Sleep and Externalizing Symptoms in Toddlers and Preschoolers.

The aim of this study was to investigate the concurrent and longitudinal relations between sleep and externalizing symptoms among young children. Sixty-four families (mostly Caucasian; 36 boys) were met twice, when children were 2 (T1) and 4 years of age (T2). At T1, children wore an actigraph monitor for a 72-hr period, and both mothers and fathers completed the Child Behavior Checklist. At T2, both parents as well as the daycare educator filled the Child Behavior Checklist. At T1, longer sleep duration and higher sleep efficiency were associated with fewer externalizing symptoms as assessed by mothers. Results also indicated that higher sleep efficiency at T1 was related to fewer parent-reported externalizing symptoms at T2 (while controlling for prior externalizing symptoms). Relations between sleep efficiency at T1 and externalizing symptoms as assessed by mothers at T1 and by fathers at T2 were moderated by child sex, such that links were significant among boys only. Results pertaining to educators' reports were inconclusive. The current study highlights the importance of rapidly treating sleep difficulties, which are associated with persistent behavioral maladjustment, perhaps especially for boys.

Sleep and attachment in early childhood: a series of meta-analyses.

Empirical findings regarding the association between child attachment and sleep have been inconsistent. The objectives of this series of meta-analyses were to assess the size of the association between child sleep and attachment and to examine whether study methodology (attachment measure, sleep measure) and age moderate this association. Sixteen studies (2783 children aged from 6 to 38 months) were included. Significant associations were found between attachment security and sleep efficiency (r = .18) and attachment resistance and sleep problems (r = .18). There were significant moderator effects of sleep measure and age of the child, with the size of the association between sleep and attachment security increasing with age (R2 analog = .67). Inconsistent findings are likely due to inter-study variabilities in methodology and to a developmental effect on the sleep-attachment association.

Viii. Attachment and sleep among toddlers: disentangling attachment security and dependency.

Many scholars have proposed that parent-child attachment security should favor child sleep. Research has yet, however, to provide convincing support for this hypothesis. The current study used objective measures of sleep and attachment to assess the longitudinal links between mother-child attachment security and subsequent sleep, controlling for child dependency. Sixty-two middle-class families (30 girls) were met twice, when children were 15 months (Wave 1; W1) and 2 years of age (Wave 2; W2). At W1, mother-child attachment was assessed with the observer version of the Attachment Q-Sort. At W2, children wore an actigraph monitor for 72 hr. Results indicated that children more securely attached to their mothers subsequently slept more at night and had higher sleep efficiency, and these predictions were not confounded by child dependency. These findings suggest a unique role for secure attachment relationships in the development of young children's sleep regulation, while addressing methodological issues that have long precluded consensus in this literature.

Investigating the Convergence between Actigraphy, Maternal Sleep Diaries, and the Child Behavior Checklist as Measures of Sleep in Toddlers.

The current study examined associations among actigraphy, maternal sleep diaries, and the parent-completed child behavior checklist (CBCL) sleep items. These items are often used as a sleep measure despite their unclear validity with young children. Eighty middle class families (39 girls) drawn from a community sample participated. Children (M = 25.34 months, SD = 1.04) wore an actigraph monitor (Mini-Mitter(®) Actiwatch Actigraph, Respironics) for a 72-h period, and mothers completed a sleep diary during the same period. Eighty-nine percent of the mothers and 75% of the fathers also filled out the CBCL (1.5-5). Mother and father CBCL scores were highly correlated. Overall, good correspondence was found between the CBCL filled out by mothers and sleep efficiency and duration derived from maternal sleep diaries (r between -0.39 and -0.25, p ≤ 0.05). Good correspondence was also found between the CBCL filled out by fathers and sleep efficiency as derived from maternal sleep diaries (r between -0.39 and -0.24, p ≤ 0.05), but not with sleep duration (all results were non-significant). Very few correlations between actigraphy and the CLBL scores reached statistical significance. The Bland and Altman method revealed that sleep diaries and actigraphy showed poor agreement with one another when assessing sleep duration and sleep efficiency. However, diary- and actigraphy-derived sleep durations were significantly correlated. Consistent with findings among older groups of children, this study suggests that the CBCL sleep items, sleep diaries, and actigraphy tap into quite different aspects of sleep among toddlers. The choice of which measures to use should be based on the exact aspects of sleep that one aims to assess. Overall, despite its frequent use, the composite sleep score of the CBCL shows poor links to objective measures of sleep duration and sleep efficiency.

My mother is sensitive, but I am too tired to know: infant sleep as a moderator of prospective relations between maternal sensitivity and infant outcomes.

This study investigated the moderating role of infant sleep in the connections between maternal sensitivity and three indicators of infant functioning: attachment security, theory of mind, and executive functioning (EF). Maternal sensitivity was assessed when infants (27 girls and 36 boys) were 1 year of age. Infant sleep was assessed with actigraphy at age 2; attachment security, theory of mind, and EF were also assessed at age 2. Results indicated that maternal sensitivity was positively related to attachment security only among infants who got more sleep at night, and to conflict-EF and theory of mind only for infants who got greater proportions of their sleep during the night. These results suggest that sleep may enhance the benefits of maternal sensitivity for some aspects of infants' functioning, providing further support for the importance of sleep maturation as a salient developmental task of infancy.

[Attitudes of general physicians and family medicine residents towards patients with borderline personality disorder]. / Attitudes des médecins omnipraticiens et des résidents en médecine familiale à l'endroit des personnes souffrant d'un trouble de personnalité limite.

OBJECTIVES: Several studies suggest that health professionals show negative attitudes towards people with Borderline Personality Disorder (BPD). Many publications have focused on the attitudes of nurses or other type of clinicians like social workers or psychologists. Few researches concern the attitudes of general physicians towards BPD even if they are the main professionals involved in the evaluation and treatment of these patients. Additionally, patients with BPD frequently consult general physicians and, because of the difficulties interacting with these patients, they do not always receive the treatments required by their condition. This research aims to assess the attitudes of general physicians and family medicine residents regarding patients presenting with this disorder. METHOD: Forty family medicine residents and thirty-five general physicians were compared to thirty-nine mental health professionals using the Attitudes toward people with BPD Scale (ABPDS; Bouchard, 2001). This measure has two subscales labeled Comfort when interacting with someone who has BPD and Positives perceptions about BPD. The internal consistency of the scale as well as the two distinct factors are satisfactory. The participants also complete a socio-demographic questionnaire. Means, t tests, ANOVAs and factorial ANOVAs are completed in order to compare the three groups on the ABPDS and explore the influence of variables such as sex, age, years of experience, and professional setting (urban or rural) on the results. RESULTS: The results show that general physicians have similar attitudes than mental health professionals towards people presenting with BPD and that family medicine residents present less positive attitude than the other two groups. In addition, clinicians with less experience tend to have less positive attitudes towards people with BPD and clinicians from urban settings seem to have more positive attitude. It was difficult to determinate which variables influence the results because the years of experience, the professional settings and the title of the participants are extremely related. The factorial ANOVAs show no interaction effect between these three variables. CONCLUSION: Several studies show that health professionals present negative attitudes toward patients with BPD. This study reveals that general physicians and family medicine residents show respectively similar attitudes or less positive attitudes than other mental health professionals. These results underline the importance of providing specific training about BPD to family medicine residents. Because general physicians guide the evaluations and interventions concerning these patients and mental health professionals interact regularly with BPD, it will be helpful if all the clinicians receive more specific training regarding this disorder.

Disturbed dreaming during the third trimester of pregnancy.

OBJECTIVE: The majority of women develop sleep impairments during pregnancy, but alterations in dream experiences remain poorly understood. This study aimed to assess prospectively and comparatively the recall of dreaming and of disturbed dreaming in late pregnancy. METHODS: Fifty-seven nulliparous, third-trimester pregnant women (mean age±SD, 28.7±4.06 years) and 59 non-pregnant controls (mean age±SD, 26.8±4.21 years) completed demographics and psychological questionnaires. A 14-day prospective home log assessed sleep and dream characteristics and the Sleep Disorders Questionnaire measured retrospective dream and disturbed dream recall. RESULTS: Even though pregnant and non-pregnant women showed similar prospective dream recall (P=0.47), pregnant women reported prospectively more bad dreams (P=0.004). More pregnant women (21%) than non-pregnant women (7%) reported a nightmare incidence exceeding moderately severe pathology (>1/week) (P=0.03). Pregnant women also reported overall lower sleep quality (P=0.007) and more night awakenings (P=0.003). Higher prospective recall of bad dreams (r = -0.40, P=0.002) and nightmares (r = -0.32, P=0.001) both correlated with lower sleep quality in pregnant women. CONCLUSIONS: Late pregnancy is a period of markedly increased dysphoric dream imagery that may be a major contributor to impaired sleep at this time. Further polysomnographic assessments of pregnant women are needed to clarify relationships between sleep and disturbed dream production in this population.

Maternal representations in the dreams of pregnant women: a prospective comparative study.

Dreams are thought to respond to self- and socially-relevant situations that evoke strong emotions and require rapid adaptation. First pregnancy is such a situation during which maternal mental representations (MMR) of the unborn baby, the self and significant others undergo remodeling. Some studies suggest that dreams during pregnancy contain more MMR and are more dysphoric, but such studies contain important methodological flaws. We assessed whether dreamed MMR, like waking MMR, change from the 7th month of pregnancy to birth, and whether pregnancy-related themes and non-pregnancy characteristics are also transformed. Sixty non-pregnant and 59 pregnant women (37 early and 22 late 3rd trimester) completed demographic and psychological questionnaires and 14-day home dream logs. Dream reports were blindly rated according to four dream categories: (1) Dreamed MMR, (2) Quality of baby/child representations, (3) Pregnancy-related themes, (4) Non-pregnancy characteristics. Controlling for age, relationship and employment status, education level and state anxiety, women in both pregnant groups reported more dreams depicting themselves as a mother or with babies/children than did non-pregnant women (all p = 0.006). Baby/child representations were less specific in the late 3rd than in the early 3rd trimester (p = 0.005) and than in non-pregnant women (p = 0.01). Pregnant groups also had more pregnancy, childbirth and fetus themes (all p = 0.01). Childbirth content was higher in late than in early 3rd trimester (p = 0.01). Pregnant groups had more morbid elements than did the non-pregnant group (all p < 0.05). Dreaming during pregnancy appears to reflect daytime processes of remodeling MMR of the woman as a mother and of her unborn baby, and parallels a decline in the quality of baby/child representations in the last stage of pregnancy. More frequent morbid content in late pregnancy suggests that the psychological challenges of pregnancy are reflected in a generally more dysphoric emotional tone in dream content.

Validating actigraphy as a measure of sleep for preschool children.

STUDY OBJECTIVES: The algorithms used to derive sleep variables from actigraphy were developed with adults. Because children change position during sleep more often than adults, algorithms may detect wakefulness when the child is actually sleeping (false negative). This study compares the validity of three algorithms for detecting sleep with actigraphy by comparing them to PSG in preschoolers. The putative influence of device location (wrist or ankle) is also examined. METHODS: Twelve children aged 2 to 5 years simultaneously wore an actigraph on an ankle and a wrist (Actiwatch-L, Mini-Mitter/Respironics) during a night of PSG recording at home. Three algorithms were tested: one recommended for adults and two designed to decrease false negative detection of sleep in children. RESULTS: Actigraphy generally showed good sensitivity (> 95%; PSG sleep detection) but low specificity (± 50%; PSG wake detection). Intraclass correlations between PSG and actigraphy variables were strong (> 0.80) for sleep latency, sleep duration, and sleep efficiency, but weak for number of awakenings (< 0.40). The two algorithms designed for children enhanced the validity of actigraphy in preschoolers and increased the proportion of actigraphy-scored wake epochs scored that were also PSG-identified as wake. Sleep variables derived from the ankle and wrist were not statistically different. CONCLUSION: Despite the weak detection of wakefulness, Acti-watch-L appears to be a useful instrument for assessing sleep in preschoolers when used with an adapted algorithm.

Infant attachment and toddlers' sleep assessed by maternal reports and actigraphy: different measurement methods yield different relations.

OBJECTIVE: To investigate relations between children's attachment and sleep, using objective and subjective sleep measures. Secondarily, to identify the most accurate actigraphy algorithm for toddlers. METHODS: 55 mother-child dyads took part in the Strange Situation Procedure (18 months) to assess attachment. At 2 years, children wore an Actiwatch for a 72-hr period, and their mothers completed a sleep diary. RESULTS: The high sensitivity (80) and smoothed actigraphy algorithms provided the most plausible sleep data. Maternal diaries yielded longer estimated sleep duration and shorter wake duration at night and showed poor agreement with actigraphy. More resistant attachment behavior was not associated with actigraphy-assessed sleep, but was associated with longer nocturnal wake duration as estimated by mothers, and with a reduced actigraphy-diary discrepancy. CONCLUSIONS: Mothers of children with resistant attachment are more aware of their child's nocturnal awakenings. Researchers and clinicians should select the best sleep measurement method for their specific needs.

Early maladaptive schemas and child and adult attachment: a 15-year longitudinal study.

OBJECTIVES: To examine the relation between early maladaptive schemas (EMS), as defined in schema therapy, and both child and adult attachment. DESIGN: A 15-year longitudinal design in which child attachment groups (secure, avoidant, ambivalent, and disorganized) were compared in early adulthood on their profile of scores across EMS domains. A similar strategy was used to examine EMS profiles as a function of adult attachment groups (secure, preoccupied, and fearful). METHODS: Sixty participants, recruited from Montreal day-care centres, were assessed at 6 (Time 1) and 21 years of age (Time 2). Time 1 attachment was assessed using a separation-reunion procedure and Time 2 attachment, using the Experiences in Close Relationships questionnaire. EMS were evaluated with the Young Schema Questionnaire (Time 2). RESULTS: There were more signs of EMS among young adults with either an insecure ambivalent child attachment, or an insecure preoccupied adult attachment style, compared to their secure peers. These differences were not specific to one domain of EMS; they were reported for various EMS. CONCLUSIONS: The results suggest that specific elements of representational models are more likely to be related to the development of EMS: high anxiety over abandonment, negative self-view, and explicit manifestations of personal distress. Unmet childhood needs for secure attachment may lead to a large variety of EMS as defined in schema therapy.

Adaptation of imagery rehearsal therapy for nightmares in children: A brief report.

This study investigated the effectiveness of a psychotherapeutic treatment for nightmares that was adapted for 6- to 11-year-old children from imagery rehearsal therapy. Ten child-mother dyads took part in a 3-session, 8-week treatment protocol. Participation in the study (contact with clinician, keeping a prospective dream log) was associated with decreases unpleasant dreams frequency, nightmare distress, and manifest anxiety. Providing educational information about nightmares did contribute to this positive effect. Results also suggest that drawing modified versions of nightmares for 1 month was associated with further reductions in nightmare distress and anxiety, but with no changes in unpleasant dreams frequency. Follow-ups at 3 and 6 months posttreatment suggest that the intervention had maintained effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved).