Oxford, Monica LHash, Jonika2018-04-242018-04-242018Hash_washington_0250E_18267.pdfhttp://hdl.handle.net/1773/41716Thesis (Ph.D.)--University of Washington, 2018Background: Maltreated infants and toddlers, and their families, live in highly stressful and challenging contexts. The stressors experienced by maltreated infants and toddlers can be harmful to their development. Sleep health is an integral component to the developing child's physical and psychological wellbeing. Yet very little sleep research has been conducted among populations of maltreated infants and toddlers. There is a lack of understanding about the sleep problems experienced by these children, how sleep may underlie their social emotional development, and how already evidenced-based, home-visiting interventions can be leveraged to have the added benefit of addressing sleep problems among maltreated infants and toddlers. Purpose: The purpose of this dissertation is to address this paucity of knowledge about sleep among maltreated infants and toddlers. There are three papers in this dissertation, all of which include a sample of dyads (parents and their 10- to 24-month-old child) from families with a CPS maltreatment report. Paper 1 examines how behavioral sleep problems associate with parents' concerns about their child's sleep among this sample of parent-child dyads from families with a CPS maltreatment report. Paper 1 also examines sleep duration among children from these families, compared to a reference sample of children uninvolved with CPS. Paper 2 examines longitudinal, transactional relations between sleep and social emotional development among this sample of infants and toddlers from families involved with CPS. Paper 3 examines if adverse childhood experiences increase the risk of having a sleep problem among this sample of infants and toddlers. Paper 3 also examines if a home-visiting, relationship-based intervention can reduce children's risk of having a sleep problem, both directly and indirectly by way of increased parenting sensitivity. Methods: All papers in this dissertation are based on a secondary analysis of a longitudinal, randomized controlled trial comparing a home-visiting, relationship-based parenting intervention to a resource and referral control condition. Participants included 247 parents and their biological 10- to 24-month-old child (n = 124 treatment condition, n = 123 control condition) from families with a CPS maltreatment report. Data were collected at approximately 3-month intervals including baseline (T1), immediately post-intervention (T2), 3 months post-intervention (T3), and 6 months post-intervention (T4). For paper 1: Only data from dyads randomized to the control condition were used. Measures included parent reports about their child's sleep (collected at T2 and T4). Reference sample means (about the children uninvolved with CPS) were extracted from a previous report. For paper 2: Only data from dyads randomized to the control condition were used. Measures included parent reports about their child's sleep problems and daily napping behavior (collected at T2), as well parent reports about their child's internalizing behaviors, externalizing behaviors, and competence (collected at all time points). For paper 3: Data from the full sample were used. Measures included parent reports about their child's sleep problems (collected at T4), an observed parenting sensitivity tool (collected at all time points), and a combination of tools used to count children's adverse childhood experiences (collected across all time points). Results: Paper 1: At T2, children's night wakings and difficulty falling asleep on their own, but not difficulty sleeping alone, significantly associated with whether or not their parent was concerned they had a sleep problem. Six months later, at T4, children's night wakings and difficulty sleeping alone, but not difficulty falling asleep on their own, significantly associated with whether or not their parent was concerned they had a sleep problem. Mean nocturnal sleep duration was significantly longer and mean nap duration was significantly shorter among children ages 24 to 36 months, compared to children of the same age in the reference sample. Paper 2: Higher baseline externalizing behavior associated with a greater propensity for parents to indicate that they were concerned their child had a sleep problem 3 months later. Higher baseline internalizing behavior also associated with a greater propensity for parents to indicate concern that their child had a sleep problem 3 months later, but only at the trend level. A greater propensity for parents to indicate concern that their child had a sleep problem associated with higher levels of internalizing and externalizing behavior 6 months later. A greater tendency for children to take a daily nap associated with lower internalizing behavior, lower externalizing behavior, and higher competence 6 months later. Paper 3: Children's adverse childhood experiences significantly associated with whether or not their parent was concerned they had a sleep problem; as the number of adverse childhood experiences increased, the odds of having a sleep problem also increased. Post hoc analyses indicated an interaction between children's adverse childhood experiences and treatment assignment such that children's odds of having a sleep problem increased as their number of adverse childhood experiences increased, but only among children in the control condition. Conclusion: This dissertation adds new knowledge to suggest that children's behavioral sleep problems were concerns that changed with development among these parents of infants and toddlers from families with a CPS maltreatment report. Findings also indicate the spread of sleep across the 24-hour period may have been different among the 24- to 36-month-old children in this sample, compared to the reference sample. In addition, children's daily napping behavior foreshadowed later social emotional functioning, while children's sleep problems both foreshadowed later and followed earlier behavior problems (especially externalizing behavior). Finally, accumulating early childhood adversity placed children at greater risk for sleep problems, but receiving a home-visiting, relationship-based intervention buffered children from this risk. Further research is needed to better understand sleep among populations of maltreated infants and toddlers.application/pdfen-USnoneAdverse Childhood ExperiencesHome visitingMaltreatmentNapsSleep problemsSocial emotional developmentNursingTo Be AssignedThesis