Asynchrony of mother–infant hypothalamic–pituitary–adrenal axis activity following extinction of infant crying responses induced during the transition to sleep

Middlemiss, Wendy; Goldberg, Wendy A.; Nathans, Laura

doi:10.1016/j.earlhumdev.2011.08.010

Cited by 82 publications

(81 citation statements)

References 30 publications

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“…The immediate stress experienced by parents while undertaking extinction-based methods can often lead to ceasing such techniques. 23,24 However, arguably more important (and central to the current article) is that the stress associated with extinction-based treatments might elevate cortisol levels that could have long-term consequences of infant helplessness, and later insecure parent-child attachments and child emotional and behavioral problems. 3,25 This antithesis to using extinction-based methods has strong support, to the extent that more gentle approaches are sought.…”

Section: Methodsmentioning

confidence: 99%

Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial

Gradisar¹,

Jackson²,

et al. 2016

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To evaluate the effects of behavioral interventions on the sleep/wakefulness of infants, parent and infant stress, and later child emotional/behavioral problems, and parent-child attachment. METHODS:A total of 43 infants (6-16 months, 63% girls) were randomized to receive either graduated extinction (n = 14), bedtime fading (n = 15), or sleep education control (n = 14). Sleep measures included parent-reported sleep diaries and infant actigraphy. Infant stress was measured via morning and afternoon salivary cortisol sampling, and mothers' self-reported mood and stress. Twelve months after intervention, mothers completed assessments of children's emotional and behavioral problems, and mother-child dyads underwent the strange situation procedure to evaluate parent-child attachment.RESULTS: Significant interactions were found for sleep latency (P < .05), number of awakenings (P < .0001), and wake after sleep onset (P = .01), with large decreases in sleep latency for graduated extinction and bedtime fading groups, and large decreases in number of awakenings and wake after sleep onset for the graduated extinction group. Salivary cortisol showed small-to-moderate declines in graduated extinction and bedtime fading groups compared with controls. Mothers' stress showed small-to-moderate decreases for the graduated extinction and bedtime fading conditions over the first month, yet no differences in mood were detected. At the 12-month follow-up, no significant differences were found in emotional and behavioral problems, and no significant differences in secureinsecure attachment styles between groups.CONCLUSIONS: Both graduated extinction and bedtime fading provide significant sleep benefits above control, yet convey no adverse stress responses or long-term effects on parent-child attachment or child emotions and behavior. Women's and Children's Health Network, Adelaide, South Australia, Australia Dr Gradisar provided co-conception and design of the study, supervision of most of the analyses and conducted the rest of analyses, signifi cant contribution to the interpretation of analyses, and was main contributor to writing of manuscript; Dr Jackson provided co-conception and design of the study, collected most of the data (pretreatment to 3 months), conducted most of the analyses, provided signifi cant input to the literature reviewed, was a minor contributor to writing of the manuscript, and provided critical evaluation of manuscript drafts; Dr Spurrier provided co-conception and design of the study, critical evaluation of manuscript drafts, and interpretation of fi ndings; Ms Gibson provided input into study design, collected most of the 12-month follow-up data, and provided interpretation of fi ndings and critical evaluation of manuscript drafts; Dr Whitham provided input into the study design, conducted data scoring and analyses of 12-month 2 Large declines in nocturnal wakefulness occur (on average) over the first 6 months of age, and plateau thereafter, 2, 5 occurring after 24-hour circadian rhythm stabilization ...

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Section: Methodsmentioning

confidence: 99%

Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial

Gradisar¹,

Jackson²,

et al. 2016

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“…Unsurprisingly parents can be concerned when they hear in a recent study that infants' stress responses to extinction remained high even after the child had stopped crying because their stress levels were still elevated. 51 This was despite a reported decrease in maternal stress levels, presumably due to the lack of crying, causing asynchrony in the mother-child dyad. Synchronicity of this dyad is foundational for the child's cognitive, social-emotional and self-regulatory skills, 52 and secure mother-infant attachment.…”

Section: Fear Of Repercussionsmentioning

confidence: 91%

“…Synchronicity of this dyad is foundational for the child's cognitive, social-emotional and self-regulatory skills, 52 and secure mother-infant attachment. 53 Findings from that study 51 suggested there could be unintended risks of extinction interventions, and many online parenting groups cited this study as "proof" of extinction being harmful. What some parents may not have seen was the response to this study from some pediatric sleep researchers who questioned study features which had the potential to alter the interpretation of findings.…”

Section: Fear Of Repercussionsmentioning

confidence: 99%

“…Indeed, some practitioners and researchers question this assumption and propose that it teaches children to "give-up," inciting learned helplessness, 38,71 and some findings may support this. 51 Limited data still restrict confidence in this proposition. Parent education in programs also follows a specific philosophy and this must be recognized.…”

Section: Misinformationmentioning

confidence: 99%

“…Some studies are presented as conclusive evidence that there are or are not harms caused by extinction 42,51 by researchers, professionals and popular writers alike. Unsurprisingly parents can be concerned when they hear in a recent study that infants' stress responses to extinction remained high even after the child had stopped crying because their stress levels were still elevated.…”

Section: Fear Of Repercussionsmentioning

confidence: 99%

See 2 more Smart Citations

Discussion of Extinction-Based Behavioral Sleep Interventions for Young Children and Reasons Why Parents May Find Them Difficult

Etherton

Blunden

Hauck

2016

Journal of Clinical Sleep Medicine

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The majority of behavioral sleep interventions for young children involve extinction procedures where parents must ignore their child's cries for a period. Many parents have difficulties with this, contributing to attrition, non-compliance, and treatment avoidance. Yet why these methods are difficult to implement has rarely been addressed in the literature. This paper discusses seven potential reasons why parents may find extinction sleep interventions difficult: enduring crying, practical considerations, fear of repercussions, misinformation, incongruence with personal beliefs, different cultural practices, and parent wellness. These reasons are discussed in relation to the current literature. Practicing health professionals and sleep researchers could benefit from an awareness of these issues when suggesting extinction interventions and offering alternatives which may be more appropriate for family circumstances and facilitate parental informed choice.

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Translating research-based knowledge about infant sleep into practice

Middlemiss

Yaure

Huey

2015

Journal of the American Association of Nurse Practitioners

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Purpose Review infant sleep research with a focus on understanding the elements related to infant safety and infant and maternal well‐being during nighttime care. Data sources This review summarizes current research and addresses the controversies and conflicting outcomes reported in infant nighttime care. This review addresses current literature on infant sleep patterns, as well as factors that influence infant sleep and are consequences of different care routines. Conversation points are provided to help nurse practitioners (NPs) address safety and practice concerns. Conclusions Shared information can help parents provide a safe and healthy environment for infants and help to facilitate communication ties between the healthcare providers and the families. Implications for practice NPs need to help parents understand infant sleep patterns norms, what is current knowledge about infant nightwakings and parental presence, as well as about approaches to altering infant sleep patterns. Integrating this knowledge with parent preferences that are influenced by cultural practices and individual differences is crucial in helping parents develop a strong sense of competence and comfort with their choices and behaviors.

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Asynchrony of mother–infant hypothalamic–pituitary–adrenal axis activity following extinction of infant crying responses induced during the transition to sleep

Cited by 82 publications

References 30 publications

Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial

Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial

Discussion of Extinction-Based Behavioral Sleep Interventions for Young Children and Reasons Why Parents May Find Them Difficult

Translating research-based knowledge about infant sleep into practice

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