How we raise young children is one of today's most highly personalized and sharply politicized issues, in part because each of us can claim some level of "expertise." The debate has intensified as discoveries about our development-in the womb and in the first months and years-have reached the popular media. How can we use our burgeoning knowledge to assure the well-being of all young children, for their own sake as well as for the sake of our nation? Drawing from new findings, this book presents important conclusions about nature-versus-nurture, the impact of being born into a working family, the effect of politics on programs for children, the costs and benefits of intervention, and other issues. The committee issues a series of challenges to decision makers regarding the quality of child care, issues of racial and ethnic diversity, the integration of children's cognitive and emotional development, and more. Authoritative yet accessible, From Neurons to Neighborhoods presents the evidence about "brain wiring" and how kids learn to speak, think, and regulate their behavior. It examines the effect of the climate-family, child care, community-within which the child grows.

/pdf/from-neurons-to-neighborhoods-the-science-of-early-childhood-3bfl5g72ow.pdf

From Neurons to Neighborhoods: The Science of Early Childhood Development

Objectives: The purposes of this study were to identify age-related changes in objectively recorded sleep patterns across the human life span in healthy individuals and to clarify whether sleep latency and percentages of stage 1, stage 2, and rapid eye movement (REM) sleep significantly change with age. Design: Review of literature of articles published between 1960 and 2003 in peer-reviewed journals and meta-analysis. Participants: 65 studies representing 3,577 subjects aged 5 years to 102 years. Measurement: The research reports included in this meta-analysis met the following criteria: (1) included nonclinical participants aged 5 years or older; (2) included measures of sleep characteristics by “all night” polysomnography or actigraphy on sleep latency, sleep efficiency, total sleep time, stage 1 sleep, stage 2 sleep, slow-wave sleep, REM sleep, REM latency, or minutes awake after sleep onset; (3) included numeric presentation of the data; and (4) were published between 1960 and 2003 in peer-reviewed journals. Results: In children and adolescents, total sleep time decreased with age only in studies performed on school days. Percentage of slow-wave sleep was significantly negatively correlated with age. Percentages of stage 2 and REM sleep significantly changed with age. In adults, total sleep time, sleep efficiency, percentage of slow-wave sleep, percentage of REM sleep, and REM latency all significantly decreased with age, while sleep latency, percentage of stage 1 sleep, percentage of stage 2 sleep, and wake after sleep onset significantly increased with age. However, only sleep efficiency continued to significantly decrease after 60 years of age. The magnitudes of the effect sizes noted changed depending on whether or not studied participants were screened for mental disorders, organic diseases, use of drug or alcohol, obstructive sleep apnea syndrome, or other sleep disorders. Conclusions: In adults, it appeared that sleep latency, percentages of stage 1 and stage 2 significantly increased with age while percentage of REM sleep decreased. However, effect sizes for the different sleep parameters were greatly modified by the quality of subject screening, diminishing or even masking age associations with different sleep parameters. The number of studies that examined the evolution of sleep parameters with age are scant among school-aged children, adolescents, and middle-aged adults. There are also very few studies that examined the effect of race on polysomnographic sleep parameters.

https://sites.oxy.edu/clint/physio/article/MetaAnalysisofQuantitativeSleepParametersFromChildhoodtoOldAgeOhayon2004.pdf

Meta-Analysis of Quantitative Sleep Parameters From Childhood to Old Age in Healthy Individuals: Developing Normative Sleep Values Across the Human Lifespan

Study objectives To present psychometric data on a comprehensive, parent-report sleep screening instrument designed for school-aged children, the Children's Sleep Habits Questionnaire (CSHQ). The CSHQ yields both a total score and eight subscale scores, reflecting key sleep domains that encompass the major medical and behavioral sleep disorders in this age group. Design Cross-sectional survey. Setting Three elementary schools in New England, a pediatric sleep disorders clinic in a children's teaching hospital. Participants Parents of 469 school-aged children, aged 4 through 10 years (community sample), and parents of 154 patients diagnosed with sleep disorders in a pediatric sleep clinic completed the CSHQ. Interventions N/A. Measurements and results The CSHQ showed adequate internal consistency for both the community sample (p=0.68) and the clinical sample (p=0.78); alpha coefficients for the various subscales of the CSHQ ranged from 0.36 (Parasomnias) to 0.70 (Bedtime Resistance) for the community sample, and from 0.56 (Parasomnias) to 0.93 (Sleep-Disordered Breathing) for the sleep clinic group. Test-retest reliability was acceptable (range 0.62 to 0.79). CSHQ individual items, as well as the subscale and total scores were able to consistently differentiate the community group from the sleep-disordered group, demonstrating validity. A cut-off total CSHQ score of 41 generated by analysis of the Receiver Operator Characteristic Curve (ROC) correctly yielded a sensitivity of 0.80 and specificity of 0.72. Conclusions The CSHQ appears to be a useful sleep screening instrument to identify both behaviorally based and medically-based sleep problems in school-aged children.

https://nationaljewish.org/njh/media/pdf/meltzer references/owens-(2000)-cshq-school-aged-children.pdf

The Children's Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children.

Autism is a neurodevelopmental disorder characterized by impaired communication and social interaction and may be accompanied by mental retardation and epilepsy. Its cause remains unknown, despite evidence that genetic, environmental, and immunological factors may play a role in its pathogenesis. To investigate whether immune-mediated mechanisms are involved in the pathogenesis of autism, we used immunocytochemistry, cytokine protein arrays, and enzyme-linked immunosorbent assays to study brain tissues and cerebrospinal fluid (CSF) from autistic patients and determined the magnitude of neuroglial and inflammatory reactions and their cytokine expression profiles. Brain tissues from cerebellum, midfrontal, and cingulate gyrus obtained at autopsy from 11 patients with autism were used for morphological studies. Fresh-frozen tissues available from seven patients and CSF from six living autistic patients were used for cytokine protein profiling. We demonstrate an active neuroinflammatory process in the cerebral cortex, white matter, and notably in cerebellum of autistic patients. Immunocytochemical studies showed marked activation of microglia and astroglia, and cytokine profiling indicated that macrophage chemoattractant protein (MCP)-1 and tumor growth factor-beta1, derived from neuroglia, were the most prevalent cytokines in brain tissues. CSF showed a unique proinflammatory profile of cytokines, including a marked increase in MCP-1. Our findings indicate that innate neuroimmune reactions play a pathogenic role in an undefined proportion of autistic patients, suggesting that future therapies might involve modifying neuroglial responses in the brain.

/pdf/neuroglial-activation-and-neuroinflammation-in-the-brain-of-34g5qush00.pdf

Neuroglial activation and neuroinflammation in the brain of patients with autism

The Autism Diagnostic Observation Schedule (ADOS), a standardized protocol for observation of social and communicative behavior associated with autism, is described. The instrument consists of a series of structured and semistructured presses for interaction, accompanied by coding of specific target behaviors associated with particular tasks and by general ratings of the quality of behaviors. Interrater reliability for five raters exceeded weighted kappas of .55 for each item and each pair of raters for matched samples of 15 to 40 autistic and nonautistic, mildly mentally handicapped children (M IQ = 59) between the ages of 6 and 18 years. Test-retest reliability was adequate. Further analyses compared these groups to two additional samples of autistic and nonautistic subjects with normal intelligence (M IQ = 95), matched for sex and chronological age. Analyses yielded clear diagnostic differences in general ratings of social behavior, specific aspects of communication, and restricted or stereotypic behaviors and interests. Clinical guidelines for the diagnosis of autism in the draft version of ICD-10 were operationalized in terms of abnormalities on specific ADOS items. An algorithm based on these items was shown to have high reliability and discriminant validity.

Autism diagnostic observation schedule: a standardized observation of communicative and social behavior.

Nineteen children (8 girls, 11 boys) were evaluated in a total of 47 three-day sessions across three summers. Children were ranked according to Tanner's stages of secondary sexual characteristics. Nocturnal sleep was recorded from 2200 to 0800 hr each night. Multiple sleep latency tests were given at 2 hr intervals from 0930 each day. Nocturnal sleep time and REM sleep time remained constant across Tanner stages. Slow wave sleep time declined progressively across Tanner stages, with a 40% reduction from prepuberty to maturity. Daytime sleepiness was significantly greater in subjects at Tanner stages 3 and 4 than at Tanner stages 1 and 2. Subjects at Tanner stage 5 tended to be as sleepy as Tanner stage 3 and 4 subjects but did not differ significantly from the less mature subjects. No gender differences were found in daytime sleepiness for children at similar Tanner stages. More mature children were significantly sleepier at 1330 and 1530 than in the late afternoon and evening.

Pubertal changes in daytime sleepiness.

This paper reports the findings of a 20-week social adjustment enhancement curriculum for boys aged 8–12. The curriculum was designed to address three areas hypothesized to be deficient in persons with HFA, AS, and PDDNOS: emotion recognition and understanding; theory of mind; and executive functions/real life type problem solving. Parents attended a semi-structured concurrent psychoeducational training meeting during children’s sessions. Statistically significant improvements in facial expression recognition, and problem solving were reported for intervention group children compared to waiting list control group children. For the intervention group (the only group for whom data were available), older and less cognitively able boy’s scores on a depression inventory decreased significantly more than younger children’s. Mother’s depression scores tended to decrease and there were significant reductions in child problem behaviors reported. Results are discussed in the context of individual differences in participant cognitive levels and profiles, symptom severity, and affect-related variables.

A Social Adjustment Enhancement Intervention for High Functioning Autism, Asperger's Syndrome, and Pervasive Developmental Disorder NOS.

:Objective:Twenty to 40% of young children are reported to have behavioral insomnias of childhood. Concerns about sleep at these ages are the most common problem expressed to pediatricians at the time of well child visits. A screening questionnaire, the Children's Sleep Habits Questionnaire

The Children's Sleep Habits Questionnaire in toddlers and preschool children.

Infant sleep problems have become prevalent as complaints of parents to clinicians during the first 2 years of the child's life. This paper reviews (1) identification of multiple etiological sources for infant sleep problems from a systems perspective, (2) the assessment of sleep disturbances, and (3) the applica- tion of intervention methods to the appropriate component of system dysfunction. These areas are reviewed by integrating research findings with clinical vignettes from our practice as pediatric sleep clinicians. RgSUME: Les probltmes du sommeil infantile sont parmi des problemes repandus dont les parents font part aux cliniciens durant les deux premieres annees de la vie de l'enfant. Cet article passe en revue (1) I'identification de multiples sources etiologiques pour les problemes du sommeil infantile dans une perspective de systeme; (2) l'evaluation des troubles du sommeil; et (3) l'application de mtthodes d'intervention au composant approprie de disfonction du systeme. Ces domaines sont passes en revue en intkgrant des resultats de recherches avec des vignettes cliniques de notre cabinet de cliniciens pediatres spkcialises dans les troubles du sommeil.

Infant sleep problems: Origins, assessment, interventions

For infants who sleep independently, the ability to self-soothe when falling asleep at the beginning of the night and following nighttime awakenings appears to be a key ingredient for the development of healthy sleep-wake patterns. Although a number of studies have described the development of sleep-wake patterns during infancy, relatively few have examined factors related to the emergence of self-soothing behavior. Theoretically, self-soothing refers to an infant’s ability to regulate states of arousal; for example, calming from crying to quiet wakefulness without parental assistance. In this study, self-soothing refers to an infant’s ability to settle to sleep at the beginning of the night and to put herself back to sleep upon awakening during the night. The purpose of the current study was to objectively monitor infant sleep-wake patterns and other variables thought to relate to the development of self-soothing across the first year of life.

The development of sleep-wake patterns follows a somewhat prescribed path during infancy. First, the 24-hour distribution of sleep changes across the first year. Newborns tend to sleep for 16–17 hours in 3–4 hour increments dispersed throughout the 24-hour day (Parmelee, Shulz, & Disbrow, 1961). By 1 year of age, the bulk of sleep shifts to the nighttime hours and sleep periods lengthen (consolidate), but the total amount of sleep per 24 hours decreases relatively little (Anders & Keener, 1985; Kleitman & Engelmann, 1953). Second, the proportions of sleep states change with age, such that rapid eye movement (REM) or active sleep decreases and non-rapid eye movement (NREM) or quiet sleep increases over the first year (Anders & Keener, 1985; Fagioli & Salzarulo, 1982). Although these basic patterns have been confirmed by numerous studies over the past 40 years, few large-scale longitudinal investigations have examined factors associated with the development of nighttime self-soothing.

The few investigations that have examined falling asleep and self-soothing after nighttime awakenings during the first year of life have shown that this ability develops in some infants, but not others, by the end of the first year (Anders, Halpern, & Hua, 1992; Keener, Zeanah, & Anders, 1988; Goodlin-Jones, Burnham, Gaylor, & Anders, 2001; Goodlin-Jones, Eiben, & Anders, 1997). During the first months of life, infants most often fall asleep during or immediately after a feeding both at the beginning and during the middle of the night; self-soothing is observed only occasionally. By 4 to 6 months of age, however, self-soothing behaviors at sleep onset and following nighttime awakenings begin to appear in some infants and tend to increase in frequency to the first birthday (Goodlin-Jones et al., 2001).

Infants who self-soothe are generally considered by parents to be better sleepers than infants who consistently need assistance to make the wake-sleep transition. Infant sleep disturbances are often brought to the attention of pediatricians during well-child visits due to the sleep disruption imposed on families (Lozoff, Wolf, & Davis, 1985). Indeed, France and Blampied (1999) define a sleep-disturbed infant as ‘one who is unable to settle back to sleep without the parents being aware of the awakening’. More precisely, awakenings are most disturbing to parents when the child cannot return to sleep on her own and requires parental intervention. For the purposes of the current investigation, these infants are considered ‘non-self-soothers’. Clearly, infants who do not develop the ability to self-soothe can create turmoil in some families.

A simple linear model that describes the emergence of self-soothing is not sufficient. A transactional model embraces the complexities of interacting systems or domains across a developmental time span (Sameroff & Fiese, 2000). A transactional perspective to self-soothing might include infant characteristics, parental characteristics, and interactions between infants and parents. Figure 1 displays a tentative model of potential domains associated with self-soothing (Anders, 1994; Goodlin-Jones, Burnham, & Anders, 2000). Variables in the four domains are thought to relate to each other and, ultimately, to whether the child is or is not able to self-soothe to sleep from the waking state. The model reflects the notion that self-regulation of wake to sleep transitions results from a dynamic, interactive process between the infant and a number of proximal and distal influences, mediated mostly through interactions with caregivers. This model is a work in progress. Thus far, partial support for the transactional model comes from small-scale and/or cross-sectional investigations (e.g., Goodlin-Jones et al., 2001). There have been no longitudinal studies specifically designed to investigate the hypothesized links.



Figure 1

A transactional model for the development of self-soothing behaviors related to wake-to-sleep state transitions. The model, derived from empirical and clinical experience, provides a framework to guide investigation. More research is required to assess ...



Within the infant domain, the variable receiving most research attention in relation to infant sleep has been temperament. Infant temperament has been consistently, albeit moderately, related to the quality of nighttime sleep (Halpern, Anders, Garcia Coll, & Hua, 1994; Minde, Popiel, Leos, Falkner et al., 1993; Scher, Tirosh, & Lavie, 1998; Van Tassel, 1985). An association between temperament and middle-of-the-night self-soothing also has been reported (Keener et al., 1988). Fathers were found to rate non-self-soothing infants as more temperamentally difficult than self-soothing infants; however, a similar relationship did not hold for mothers’ ratings of temperament. Minde and colleagues (1993) reported an association between difficult temperament and problem sleep. In their study, problem sleepers were unable to return to sleep without a parental intervention (i.e., they were non-self-soothers).

Parental factors also have been associated with infant sleep disruption. Seifer and colleagues (Seifer, Sameroff, Dickstein, Hayden, & Schiller, 1996) reported an association between both higher levels of maternal mental illness and lower levels of overall family functioning and bedtime problems in toddlers. Benoit, Zeanah, Boucher, and Minde (1992) found that all of the sleep-disturbed toddlers in their sample had mothers with insecure attachment styles. Another study, however, failed to find a relation between maternal psychological well-being and infants’ tendency to self-soothe during the night. This null finding may have been due to the non-clinical range of maternal depression scores reported in this study (Goodlin-Jones et al., 2001).

Associations between the sleep context and sleep-wake domains and self-soothing have been illustrated most clearly to date. Infants who are placed into their cribs awake at the beginning of the night and who use a sleep aid are more likely to self-soothe than their counterparts (Anders et al., 1992; Goodlin-Jones et al., 1997). In addition, self-soothing infants have longer continuous sleep periods and longer total sleep times at night (Anders et al., 1992; Goodlin-Jones et al., 2001). There is clearly some evidence in support of the relationships between each of the model domains and nighttime self-soothing. A more detailed review of these associations has been published recently (France & Blampied, 1999).

The current study had three goals. As the first relatively large-scale longitudinal study to objectively investigate infant sleep, the first goal was to replicate previous work on the basic patterns of sleep-wake development across the first year of life. The second goal was to test a double blind, random assignment intervention trial to enhance self-soothing at night. The third goal was to identify potential factors leading to the development of self-soothing at 12 months of age.

Thomas F. Anders

Papers

Pubertal changes in daytime sleepiness.

A Social Adjustment Enhancement Intervention for High Functioning Autism, Asperger's Syndrome, and Pervasive Developmental Disorder NOS.

The Children's Sleep Habits Questionnaire in toddlers and preschool children.

Infant sleep problems: Origins, assessment, interventions

Nighttime sleep-wake patterns and self-soothing from birth to one year of age: a longitudinal intervention study.