Abstract
During sleep, there is high neurological and physiological activity that is important for the developing brain, necessitating normative sleep development in infants and young children between the ages of 0 and 4. Thus, non-normative sleep disturbance in young children has significant impact on the development of attention span, emotion control, impulse control,cognition, language and learning capabilities (Fallone, Owens & Deane, 2002; Gomez, Bootzin, & Nadel, 2006; Henderson et al., 2012). Moreover, there are reciprocal negative implications of child sleep disturbance on caregivers such as poor sleep quality which often leads to lower levels of physical and mental wellbeing (Lee et al., 2018). Infant sleep disturbance is a highly prevalent phenomenon, with 20% of infants aged 12 months experiencing inconsistent patterns of sleep at night (Jenkins et al., 1980; Anders & Keener, 1985). In 50% to 70% of these cases, disturbances persist into 24 months, eventually becoming chronic if still present at 36 months (Minde et al., 1993). Thus, research aimed at determining causative factors of poor sleep quality in children is essential. Causative factors that are being investigated are the contribution of parent and child characteristics to young children's sleep problems, notably through the Transactional Sleep Wake Model, which this literature review aims to examine (Goodlin-Jones et al., 2000). Furthermore, this review will critically evaluate the psychometric validity and reliability of measurements used to test the Transactional Model, and the methodological limitations of sleep research. Normative Sleep Development in Young Children Aged 0-4
Sleep is governed by two neurological processes, the circadian and homeostatic process. The circadian rhythm is an internal ‘clock’ that mediates wakefulness and sleep based on the light dark cycles during the day (Gruber et al., 2014). The homoeostatic process is based on maintaining equilibrium between wakefulness and sleep, where the need for sleep progressively increases during waking hours (Davis, Heller, & Frank, 1999). During normative development, infants between 0 to 12 months develop a synchronised circadian rhythm and typically sleep 14 to 15 hours per day with the majority of sleep occuring at night (Anders et al., 1995). Between ages 1 to 4, there is greater development of homeostatic processes where the need for sleep decreases from infancy. By age 2, sleep is typically 13 hours a day, and by 3 to 4, sleep is typically 12 hours a day (Roffwarg et al., 1966). Here, the majority of sleep is during the night (Sheldon, 2002).
Non-Normative Sleep Development in Young Children Aged 0-4
Deviations from normative sleep have been classified into two categories: problems waking during the night, or problems getting to sleep (Richman, 1981). Problems waking during the night involve waking 3 or more times in the night, around 4 times a week for more than 20 minutes per night. Problems getting to sleep involve refusing to go to sleep for longer than 30 minutes or requiring a parent being present to help them fall asleep.
The Transactional Sleep Wake Model
Goodlin-Jones et al.’s (2000) Transactional Sleep Wake Model frames the causative factors of these sleep problems within two dynamic and interactive dimensions of influence. These consist of proximal influences which relate to psychosocialization and parent-child
characteristics, and distal influences which relate to cultural context and indirect environmental influences. This review investigates proximal influences including primary caregiver characteristics such as attachment style, and child characteristics such as temperament. These proximal influences will be examined to determine whether there is an interaction between primary caregiver characteristics and child characteristics, of which the Transactional Model posits that this interaction impacts children's sleep quality. However, empirical research only provides moderate support for the Transactional Model with methodological inconsistencies impacting the efficacy of results.
The Interaction Between Parent Behaviour and Children’s Temperament on Sleep Quality
One proximal influence that the Transactional Model implicates in child sleep disturbance is child temperament and emotional regulation, which are essential components for infants and young children's developing ability to sleep, as this helps initiate and maintain sleep during the night (Burnham et al., 2002). One longitudinal study by Burnham and others (2002) found that no dimension of temperament, in isolation, related to a child's ability to independently emotionally regulate, and instead, they found a dynamic interaction between parent behaviour (such as waiting to respond to an infant's cries) with children's ability to emotionally regulate. Both, in combination, led to additive effects of an infant being able to more effectively emotionally regulate at 12 months, and thus more effectively sleep through the night.
By exposing how child temperament, in isolation, does not predict children's emotional regulation or sleep quality on its own, this provides support for the Transactional Model as it implies that a dynamic interplay must exist between parent behaviour and child temperament in order for children's sleep quality to be impacted. Burnham and others (2002) used the Infant Behavior Questionnaire (Rothbart, 1981), which has adequate internal consistency with moderate inter rater reliability (Parade & Leerkes 2008), but some conceptualization issues between items of ‘fear’ and ‘social fear’ due to difficulty in defining these constructs (Gartstein & Rothbart, 2003). Despite issues of subjectivity in self-reporting, Burnhams evidence suggests that parents of poor sleepers can accurately report a child's sleep when measured against direct observations (Minde et al., 1993) enhancing validity of parent report. However, one prevailing psychometric issue in temperament research is confounding variables. One study done by Sanson, Prior and Kyrios (1990) found that there was a large overlap in items between temperament and behavioural questionnaires, implicating research outcomes. Despite this, the moderate evidence in support of Infant Behaviour Questionnaire scale paired with good support for parental questionnaires, enhances the validity of Burnhams (2002) findings. Evidently, a combination of parent and child characteristics can contribute to a child's inability to emotionally regulate, contributing to sleep problems. Such evidence provides support for the Transactional Model.
The Interaction Between Parent Attachment Styles and Children’s Sleep Quality Another proximal influence of the Transactional Model, is the impact of parent characteristics, such as parental attachment style, on children's sleep. Attachment theory suggests that, in early childhood, interactions with parents create mental representations that guide future relationships with others (Bowlby, 1969-1982; Cassidy & Shaver, 1999), leading to healthy or unhealthy behaviours or coping strategies that arise as a result of these representations (Adams, Stoops & Skomro, 2014). Ainsworth further developed this theory by categorising three different types of relationship representations in infants: secure, avoidant, and anxious ambivalent, of which these attachment styles developed in infancy continue throughout adulthood (Ainsworth et al., 1978). Using the basis of this theory, numerous research has found a relationship between a parent’s attachment styles that they developed in infancy, and the quality of their child’s sleep. Parents with secure attachment styles have infants with better emotional regulation (Ainsworth et al., 1978; Sroufe et al., 2000) which is hypothesised to impact children's sleep as securely attached mothers encourage independent behaviour, leading to better self regulation, and thus, better sleep quality during the night (Minde et al., 1993). Conversely, one study found that children who were poor sleepers had mothers with an anxious attachment style (Benoit et al., 1992).
This suggests that parents' interactions with their children are characterised by their own attachment styles, which impacts their child's own attachment style. This is supported by how infants who developed an anxious attachment style had a higher number of night wakings against those infants that developed an avoidant attachment style (Beijer et al., 2011). Infants that developed a secure attachment style were positively associated with sleep efficiency (Scher & Asher 2004).
Research Limitations to the Transactional Model
Despite these findings, these proximal influences may not be causative of children's poor sleep, but rather correlational, which further research should aim to refine. Moreover, the majority of research on the causative factors of sleep problems in young children is focused on mothers, and there is insubstantial research focusing on father-child interactions. A holistic view of mother and father characteristics is essential for developmental research as one study revealed how women scored significantly higher on anxious attachment, and men scored higher on avoidant attachment styles (Gugova & Heretik, 2011). Further research should investigate how different attachment styles in both mothers and fathers have different effects on child's sleep problems, as this may impact a child's sleep quality or the type of sleep problem they develop.
Despite these conceptual issues, through the framework of the Transactional Model, there is moderate evidence to suggest that sleep disturbances begin at the interaction between parent and child, of which these interactions are highly influenced by parent characteristics of attachment style. However, more robust methodological practices are needed in research to further determine a strong causation, rather than a moderate relationship.
Conclusion
Research suggests that the interaction between parent and child characteristics impact a child's sleep quality, providing moderate support for the Transactional Model. However, methodological limitations impact the inferences that can be concluded from research findings.
Research suggests that parental behaviour and child temperament additively led to poor sleep quality in children. However, issues with confounding variables and psychometric conceptualisation of scale items impacts the validity of results. Furthermore research supports a positive relationship of parental attachment style on the quality of their child's sleep. However, more experimental research is needed to determine if this relationship is causative.
Finally, there is insubstantial research examining the impact of fathers' attachment styles on children's sleep quality, and a dominant research focus on mothers. Thus, more robust methodologies are needed to further enhance findings in support for the Transactional Model, but the current literature is clinically applicable for parents of poor sleepers. Written By: India Hodgson
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