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The Predictive Role of Maladaptive Parental Behaviors, Early Sleep Problems, and Child/Mother Psychological Factors

Valérie Simard, MSc, MPs; Tore A. Nielsen, PhD; Richard E. Tremblay, PhD; Michel Boivin, PhD; Jacques Y. Montplaisir, MD, PhD

Arch Pediatr Adolesc Med. 2008;162(4):360-367.

Objective  To determine if maladaptive parental behaviors (at age 29-41 months) and mother/child psychological characteristics predict future sleep disturbances in 50-month-old to 6-year-old preschoolers, while controlling for early (age 5-17 months) sleep and sociodemographic factors.

Design  Randomized survey; children assessed annually from 5 months to 6 years of age.

Setting  Participants' homes.

Participants  Representative sample of 987 children born in the province of Quebec, Canada, in 1997-1998.

Main Outcome Measures  Questionnaires and interview, including responses from 7 points for 3 key dependent measures: bad dreams (BD), total sleep time (TST) less than 10 hours/night, and sleep-onset latency (SOL) of 15 minutes or more.

Results  Early (age 5-17 months) sleep disturbances predicted maladaptive parental behaviors (eg, mother present at sleep onset, giving food/drink after child awakens) at ages 29 and 41 months. Some parental behaviors in turn predicted future BD, TST less than 10 hours/night, and SOL of 15 minutes or more. However, most relationships did not remain significant in adjusted models that controlled for early sleep problems. Bad dreams were predicted by psychological variables (child's anxiety, mother's feeling of efficacy), as was TST (child's difficult temperament and anxiety, mother's depressive symptoms). However, SOL of 15 minutes or more was predicted by several parental behaviors even in adjusted models; cosleeping after awakenings was a risk factor while mother's presence at sleep onset was a protective factor.

Conclusions  Findings support the hypothesis that maladaptive parental behaviors develop in reaction to preexisting sleep difficulties. Further, early sleep difficulties are more predictive than parental behaviors in explaining BD and foreshortened TST beginning at age 50 months. Results are interpreted in light of early emotive/physiological self-regulation problems.

Author Affiliations: Centre d’étude du sommeil, Hôpital du Sacré-Cœur de Montréal (Ms Simard and Drs Nielsen and Montplaisir) and Departments of Psychology (Ms Simard) and Psychiatry (Drs Nielsen and Montplaisir) and Research Unit on Children's Psychosocial Maladjustment (Drs Tremblay and Boivin), Université de Montréal, Montreal, and Department of Psychology, Laval University, Quebec City (Dr Boivin), Quebec, Canada.

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