Sleep Tight, Act Right: Negative Affect, Sleep and Behavior Problems During Early Childhood.

Temperamental negative affect and insufficient sleep have been independently associated with behavior problems during early childhood. However, it is unknown whether these factors interact to contribute to behavioral difficulties in young children. The current study examined the interactions between temperamental negative affect and both sleep onset time and sleep midpoint, assessed by actigraphy, in predicting externalizing and internalizing behaviors in a sample of 117 children (34-69 months of age). Children with high temperamental negative affect and either later sleep onset time or later sleep midpoint were more likely to exhibit externalizing and internalizing behaviors. These results emphasize the association between temperamental negative affect and behavioral difficulties, particularly for children with insufficient sleep.

Maternal Depressive Symptoms and Household Income in Relation to Sleep in Early Childhood.

OBJECTIVE : Sleep health is critical for children to adapt to evolving cognitive-socioemotional contexts. Given that sleep timing in early childhood is instituted under caregiver control, the family context likely has an influential role on children's sleep. This study investigated links between maternal depressive symptoms and variability in children's sleep, and whether household income moderated this relation. METHOD : 90 children (Mage = 53 ± 9 months) wore actigraphs to objectively measure sleep for 4-16 days. Mothers reported income and depressive symptomatology. RESULTS : Higher maternal depressive symptoms were related to greater variability in 24-hr sleep duration. Income moderated this relation. Lower income, but not maternal depressive symptoms, was linked to greater variability in sleep onset time. CONCLUSIONS : Findings demonstrate important relations between maternal depressive symptoms, income, and children's sleep. Understanding distal and proximal family characteristics that may be related to children's developing sleep schedules could help identify populations and strategies for promoting optimal sleep health.

Prenatal tobacco exposure and self-regulation in early childhood: Implications for developmental psychopathology.

Prenatal tobacco exposure (PTE) has a well-documented association with disruptive behavior in childhood, but the neurocognitive effects of exposure that underlie this link are not sufficiently understood. The present study was designed to address this gap, through longitudinal follow-up in early childhood of a prospectively enrolled cohort with well-characterized prenatal exposure. Three-year-old children (n = 151) were assessed using a developmentally sensitive battery capturing both cognitive and motivational aspects of self-regulation. PTE was related to motivational self-regulation, where children had to delay approach to attractive rewards, but not cognitive self-regulation, where children had to hold information in mind and inhibit prepotent motor responses. Furthermore, PTE predicted motivational self-regulation more strongly in boys than in girls, and when propensity scores were covaried to control for confounding risk factors, the effect of PTE on motivational self-regulation was significant only in boys. These findings suggest that PTE's impact on neurodevelopment may be greater in boys than in girls, perhaps reflecting vulnerability in neural circuits that subserve reward sensitivity and emotion regulation, and may also help to explain why PTE is more consistently related to disruptive behavior disorders than attention problems.

Dose of early intervention treatment during children's first 36 months of life is associated with developmental outcomes: an observational cohort study in three low/low-middle income countries.

BACKGROUND: The positive effects of early developmental intervention (EDI) on early child development have been reported in numerous controlled trials in a variety of countries. An important aspect to determining the efficacy of EDI is the degree to which dosage is linked to outcomes. However, few studies of EDI have conducted such analyses. This observational cohort study examined the association between treatment dose and children's development when EDI was implemented in three low and low-middle income countries as well as demographic and child health factors associated with treatment dose. METHODS: Infants (78 males, 67 females) born in rural communities in India, Pakistan, and Zambia received a parent-implemented EDI delivered through biweekly home visits by trainers during the first 36 months of life. Outcome was measured at age 36 months with the Mental (MDI) and Psychomotor (PDI) Development Indices of the Bayley Scales of Infant Development-II. Treatment dose was measured by number of home visits completed and parent-reported implementation of assigned developmental stimulation activities between visits. Sociodemographic, prenatal, perinatal, and child health variables were measures as correlates. RESULTS: Average home visits dose exceeded 91% and mothers engaged the children in activities on average 62.5% of days. Higher home visits dose was significantly associated with higher MDI (mean for dose quintiles 1-2 combined = 97.8, quintiles 3-5 combined = 103.4, p = 0.0017). Higher treatment dose was also generally associated with greater mean PDI, but the relationships were non-linear. Location, sociodemographic, and child health variables were associated with treatment dose. CONCLUSIONS: Receiving a higher dose of EDI during the first 36 months of life is generally associated with better developmental outcomes. The higher benefit appears when receiving ≥91% of biweekly home visits and program activities on ≥67% of days over 3 years. It is important to ensure that EDI is implemented with a sufficiently high dose to achieve desired effect. To this end groups at risk for receiving lower dose can be identified and may require special attention to ensure adequate effect.

Sleep and behavior of preschool children under typical and nap-promoted conditions.

BACKGROUND: Children transition out of naps in early childhood. However, there is disagreement about when this transition should occur. AIMS: We compared measures of sleep and behavior in children divided into Frequent, Sometimes, and Rarely nappers to determine what factors predict when napping should cease. We then examined the effect of an experimenter-promoted nap on measures of sleep and behavior. METHODS: We studied 133 children (50.4% female; mean=52.77months) over 16 days. Parents completed questionnaires, whereas children wore actigraphs. On 1 study day, children were nap-promoted. RESULTS: Overnight sleep duration was significantly less for children who napped frequently than those who rarely napped, yet total 24-hour sleep and other sleep parameters did not differ across napping groups. Effortful control was marginally greater in those who rarely napped. Nap promotion was 91% successful across nap groups. When typical sleep was compared with sleep following a promoted nap, frequent nappers slept more on the nap-promoted night. Total 24-hour sleep increased in all children following the promoted nap, and other sleep parameters did not differ between groups. CONCLUSIONS: The emergence of self-regulatory behaviors may predict when children should cease napping, consistent with the hypothesis that transitioning out of naps may be related to brain maturation. Given previously reported benefits of sleep on cognition and the observed increase in 24-hour sleep following nap promotion, nap promotion may benefit early education. Further research should explore maturational cues that illuminate when children are ready to transition out of napping.

Dropping out of outpatient psychiatric treatment: a preliminary report of a 2-year follow-up of 1500 psychiatric outpatients in Kermanshah, Iran.

BACKGROUND: Outpatient psychiatric treatment provides both psychotherapy and pharmacotherapy for a large portion of psychiatric patients. Dropping out, or early termination of treatment, may be considered a common barrier to outpatient's psychiatric treatment. There are limited studies on this issue in Iran. The current study aimed to examine rates, predictors and reasons of dropping out of an outpatient psychiatric treatment. MATERIALS AND METHOD: In this 6-month cohort study, 1500 outpatients who visited 10 psychiatrist's offices in the Iranian city of Kermanshah were recruited and followed for 2 years (2009-2011) for recommended treatments including admission to hospital, pharmacotherapy, psychotherapy and a combination of both psychotherapy and pharmacotherapy. Characteristics of patients who dropped out of the current study were collected, and reasons for dropping out were collected via phone or in person interview. RESULTS: Dropouts were prevalent in prescribed treatments. Pretreatment (primary) dropout rates in psychotherapy treatment were 4 times greater than dropout rates in pharmacotherapy treatment (80% and 20%, respectively). There were significance differences between dropouts and non-dropouts of pharmacotherapy with respect to patient characteristics; younger age, male gender, low level of education, unemployment, lack of insurance, new cases and divorce were more prevalent among dropouts (P<.001). With regard to diagnosis, dropping out was more prevalent among patients with substance-related disorders, schizophrenia and other psychotic disorders when compared to other diagnoses (P<.001). Commonly reported reasons for dropping out included overslept and too ill to attend treatment and fear of becoming addicted to prescribed psychotropic medication (30% and 18%, respectively). Lack of confidence in therapist ability and lack of confidence in the efficacy of the treatment were more prevalent in patients who dropped out of psychotherapy (P<.001). CONCLUSION: Patient dropout is a common problem in outpatient psychiatric treatment, particularly in psychotherapy treatment. Further research on reasons for dropping out and strategies to reduce rates of dropouts is recommended.