Introduction to The Oxford Handbook of Infant, Child, and Adolescent Sleep and Behavior
Abstract and Keywords
This introductory chapter outlines the history and the theoretical basis for studying child and adolescent sleep and development. Furthermore, this chapter celebrates the progress the field has made in the last few decades, and makes the case for the crucial role sleep plays in child development. The chapter describes the organization of the handbook, outlining the many foundation and topical areas of sleep and child development covered in the text.
Welcome to The Oxford Handbook of Infant, Child, and Adolescent Sleep and Behavior that has the honor of being a part of the Oxford Library of Psychology. Recognition of the significance of sleep in the cognitive and behavioral development and emotional well being of infants, children, and adolescents is relatively recent. Over the last three decades, there has been an explosion in research focused on developmental changes in sleep and circadian rhythms from birth through adolescence. Further study has led to the characterization and assessment of sleep disorders unique to different developmental stages. Links between sleep problems and overall health, as well as emotional and behavioral disorders including depression, attention deficithyperactivity disorder (ADHD), neurodevelopmental disorders, and post-traumatic stress disorder, are now more established in children and adolescents.
Ahead of psychologists in the field, graduate programs, and psychology’s professional associations, the editors of the Oxford Library of Psychology recognized the importance of including a volume on infant, child, and adolescent sleep and behavior in their Psychology Handbook series. My co-editor and I were thrilled to be a part of this significant and historic venture. As a child clinical psychologist, I was deeply committed to inviting experimental, clinical, school, and developmental psychologists as well as other behavioral clinicians and social and behavioral science researchers to author and coauthor chapters for what would become The Oxford Handbook of Infant, Child, and Adolescent Sleep and Behavior. Psychologists play a crucial role in developing and contributing to what is known as pediatric and adolescent sleep medicine; however, psychology, as a discipline, has only gradually recognized the importance of sleep in child development and developmental psychopathology research and in clinical, counseling, and school psychology undergraduate and graduate education. It is our hope that this first psychology handbook on child and adolescent sleep will inform child and adolescent clinical psychology practice, raise the importance of including child and adolescent sleep as a part of graduate programs in psychology and related fields, and provide future questions and directions for research in psychology and in the behavioral sciences.
As a child clinical psychologist, I have devoted my research program to studying sleep and daytime functioning in infants, children, and adolescents, (p. 2) as well as pregnant and postpartum women, since my graduate school days in the 1980s. At that time, few psychology graduate programs or individual faculty offered graduate-level courses on sleep or circadian rhythms. Psychologists, however, were beginning to lead a movement toward cognitive-behavioral approaches to treating insomnia. For example, while I was a graduate student in clinical psychology at Washington University in St. Louis (1982–1987), two faculty members, Patricia Lacks and Amy Bertelson, studied sleep in adults. Patricia Lacks developed stimulus control techniques for treating insomnia and wrote one of the first books on the treatment of insomnia, Behavioral Treatment for Persistent Insomnia (1987), and Amy Bertelson taught an exciting and popular undergraduate course on sleep. In contrast, scholarship on the development of sleep patterns over the course of infancy, childhood, and adolescence or on understanding and treating children’s sleep problems was far less common. Observing my mentors’ passion for helping adults improve their sleep and daytime lives, I was determined to study and understand how psychologists could contribute to improving children’s sleep. As a graduate student, I began my ongoing, nearly 30-year inquiry into understanding how children’s nighttime behaviors and sleep experiences influence not only their own daytime functioning, but also the lives of their parents and families.
Focused on the impact of healthy lifestyles as an approach to preventing mental health and behavioral difficulties in children, I started reading some of the mid-1980s publications, written by parents as well as pediatricians, on infant sleep. In particular, I focused on two parenting books: pediatrician Richard Ferber’s Solve Your Child’s Sleep Problems (2006) and parents’ Joanne Cuthbertson and Susanna Schevill’s Helping Your Child Sleep Through the Night (1985). Utilizing behavioral and social learning theories of behavior change and Cuthbertson and Schevill’s insights on self-soothing and infants’ developing ability to sleep through the night, I developed a preventive-intervention program that gave parents sleep knowledge and strategies along with a sense of self-competence to handle their infant’s sleep during the first year. The empirical findings from this preventive approach were published (see Chapters 37 and 39 for summaries) in the Journal of Consulting and Clinical Psychology (Wolfson, Lacks, & Futterman, 1992), launching early attention to parenting and young children’s sleep in the psychology literature. It took some time, however, before the child psychology discipline recognized that there were developmental changes in sleep and clear clinical and behavioral consequences for inadequate and poor quality sleep on developing youth. For example, when I presented my doctoral research on the effects of parent training on infants’ sleep patterns at the 1988 Association for the Advancement of Behavior Therapy’s (AABT) annual meeting, Jodi Mindell (coauthor of Chapter 37) and I gave the only presentations focused on behavioral approaches for improving children’s sleep and at the 1995 biannual meeting of the Society for Research on Child Development (SRCD) only 0.3% of the peer-reviewed posters and presentations were related to children’s sleep. In fact, in a shared van ride to that 1995 Seattle meeting of SRCD, a school psychologist asked me if sleep was developmental? With that story in mind, it was particularly meaningful to publish “Sleep Schedules and Daytime Functioning in Adolescents” in Child Development (Wolfson & Carskadon, 1998) with my coauthor and mentor, Mary Carskadon (coauthor of Chapter 8). Sleep, in striking contrast, is considered a focal area for the 2013 biannual meeting of the SRCD. The publication of this handbook underscores how far the behavioral and developmental sciences have come in recent years in the study, treatment, and public awareness of sleep and behavior in children and adolescents.
Over the last three decades, psychologists, pediatricians, and other health care providers have established an increasingly distinct understanding of children and adolescents’ sleep demands, circadian timing, underlying bioregulatory processes, and environmental constraints. At the beginning of this handbook, in Chapters 2 and 3, respectively, Stephen Sheldon provides an overview of the history of child and adolescent sleep medicine and Tonya Palermo offers insights and historical background regarding psychology’s historical contributions to infant, child, and adolescent sleep research. Studies have documented the clear consequences of insufficient and inconsistent sleep over the course of development, such as early behavioral and cognitive problems, poor academic performance, substance abuse, and emotion regulation difficulties. This critical area of child development and health research has begun to inspire public policy discussions and debates in areas such as school start times, regulation of preschool napping, and adolescent drivers’ education laws and programs. Likewise, much of this research has practice implications and applications not only for infants, children, and adolescents with sleep disorders, but also for those who have no demonstrable (p. 3) sleep disorders. In other words, school pressures and schedules, family socioeconomic status, and a range of environmental constraints and challenges compromise the sleep of increasingly greater numbers of infants, children, adolescents, and emerging adults. Furthermore, children and adolescents who present with academic and behavior problems may in fact have primary sleep difficulties. The basic research and clinical presentations that are discussed in this handbook have clear implications for the overall health, development, emotional well being, and academic performance of children and adolescents.
The scientific study of sleep is a still a relatively young discipline, but tremendous gains in knowledge have been achieved over the last two decades, including advancing our understanding of sleep’s role in memory consolidation and learning processes, associations between sleep deprivation and obesity, and the sleep and the circadian systems’ regulatory influence on immune functions (Besedovsky, Born, & Lange, 2012; Knutson, Zhao, Mattingly, Galli, & Cizza, 2012; Walker & Stickgold, 2006). Although the preponderance of research on sleep has been conducted in adult populations, a significant body of knowledge and current research now focuses on the sleep patterns, disruptions, and disorders in infants, children, and adolescents.
This handbook offers a unique and important contribution to the field of child and adolescent sleep patterns, difficulties, and disorders. It provides behavioral and developmental approaches to understanding sleep and circadian timing development, assessment of sleep patterns and problems, etiology of sleep disorders, and preventive/intervention approaches in working with children, adolescents, and their families. We have brought together psychologists and other behavioral and developmental clinicians and developmental scientists to discuss developmental changes in sleep and circadian rhythms; the factors that influence, mediate, and moderate sleep patterns and problems over infancy, childhood, and adolescence; and the assessment and behavioral treatment of infant, child, and adolescent sleep problems and disorders. The authors are from a range of countries and include psychologists, pediatricians, psychiatrists, nurses, child life specialists, and other health care providers and researchers with expertise on infant, child, and adolescent sleep.
Research on children’s sleep can be organized into seven areas, which are reflected here. The first section focuses on Sleep and Development, since one of the most significant factors affecting sleep is age or developmental stage. Following the two historical chapters mentioned earlier, Angela Staples and Jack Bates articulate what it means to consider sleep from a developmental perspective, so that developmental psychologists and other researchers might consider the role of sleep and circadian rhythms in development, and to remind sleep researchers how sleep changes from infancy through adolescence. Sleep and circadian rhythms change over the course of development from infancy into the emerging adult years, as highlighted and documented in the chapters by Kurt Lushington, Yvonne Pamula, Alfred James Martin, John Declan Kennedy and by Mary Carskadon and Leila Tarokh in Chapters 5, 6 and 8, respectively. An infant’s sleep plays a particularly significant role in the lives of new parents, and Robyn Stremler’s Chapter 7 examines the impact of infants’ sleep and behavior on parents including marital satisfaction, coping strategies, postpartum depression, and the parents’ own sleep-wake patterns. Although this section does not include a separate chapter on elementary school children’s sleep, school-age children’s sleep is discussed throughout the book with particular emphasis in Chapters 10, 11, 15, 21, 22, 27, and 34. Toward the end of Mary Carskadon and Leila Tarokh’s chapter, they discuss an understudied developmental stage: emerging adulthood. Historically, sleep researchers, similar to researchers in other behavioral sciences, have invited college-age students to participate in studies and then generalized to wider adult populations. However, the American Psychological Association considers youth ages 10–18 as adolescents and emerging adults ages 19–29. Psychologist Jeffrey Arnett argues that emerging adulthood, or the “winding road from the late teens through the twenties,” is a distinct and normative developmental or life stage (Arnett, 2004). Recent studies point out that first-year college students exhibit weeknight bed and rise times that are over an hour later than high school–age adolescents, as well as significantly later bed and rise times than older third and fourth-year college students (i.e., Lund, Reider, Whiting, & Prichard, 2010). Similarly, Roennberg, Kuehnle, Pramstaller, and colleagues found that after age 20, sleep midpoint times became increasingly earlier again; in other words, sleep schedules seem to become increasingly delayed over the course of adolescence, yet this pattern seems to change by the third or fourth year of college—which generally corresponds to about ages 20–22 (Roennberg, Kuehnle, Pramstaller, et al., 2004). As I emphasize in my 2010 Journal of Adolescent Health editorial, (p. 4) these remarkable cross-sectional findings suggest a developmental change; however, more research is needed to better understand and inform developmental science researchers, educators, and health care providers regarding the longitudinal trajectory of sleep and circadian timing over the late adolescence / emerging adulthood years (Wolfson, 2010).
Likewise, with each developmental period a myriad of different factors influence an infant’s, child’s, or adolescent’s sleep patterns and, likewise, the sleep environment (i.e., college dorm room vs. family sleep environment), context, and other factors such as culture and socioeconomic status, interact with developmental changes in sleep. I was quite disturbed to learn that a 12-year-old in my National Institute of Child Health and Human Development (NICHD)–funded study of urban middle schoolers was sleeping in his neighbor’s apartment until about midnight on school nights until his mother got home to awaken and escort him back to their apartment building for the remainder of the night—not an easy way to obtain the sufficient and consistent sleep needed for a developing adolescent. The second section of the book focuses on the Complexity of Issues and Factors Influencing Sleep. Here, authors Charles Super and Sara Harkness, Lauren Hale, Michael Gradisar and Michelle Short, Melissa Burnham, Lisa Meltzer, and James Spilsbury discuss and critique the newest research on the social, cultural, and economic determinants of children’s sleep, with focus on the consequences of chronic illness and violent environments, and the rapidly changing role of technology that is interfering with childrens’ and adolescents’ ability to sustain healthy sleep-wake patterns. For example, in the National Sleep Foundation’s 2011 Sleep in America Poll about in one in ten of 13–18-year-olds (9%) acknowledge that they are awakened after they go to bed every night or almost every night by a phone call, text message, or email, and nearly one in five of 13–29-year-olds note that this happens at least a few nights per week (NSF, 2011). In other words, adolescents’ and emerging adults’ lifestyle choices are creating a sleep disorder-like phenomenon with smart phones.
Parts three and four reflect the substantial literature on disordered sleep and sleep problems that manifest over the course of infancy, childhood, and adolescence. Section Three, Assessment of Sleep and Sleep Problems, articulates the range of clinical and research-based approaches for assessing and estimating sleep and circadian rhythms in infant, child, and adolescent populations. Authors Neville Blampied, Rosemary Horne and Sarah Biggs, Stephanie Crowley, Karen Spruyt, Valerie Crabtree, Amanda Rach, and Heather Gamble; Lissy Zaremba, and Joseph Buckhalt cover behavioral analysis, use of actigraphy and diaries or logs for estimating sleep patterns, and self-report measures, as well as school psychologists’ roles and clinical lab protocols. Although the field has progressed in recent years, validation of retrospective self- and parent report sleep measures, prospective sleep-wake diaries, and actigraphy are still needed. It remains difficult to study children’s sleep longitudinally, since few measures have been validated across developmental stages. Moreover, although actigraphy (in corroboration with sleep diaries) is a more objective means to estimate sleep in child and adult populations, researchers and clinicians need to establish unambiguous guidelines and standards for the scoring and reporting of actigraphy findings. Pending such standards, psychologists, other behavioral scientists, and health care providers need to be conscientious when using actigraphy and clearly report scoring rules and variables. As my colleagues and I have discussed extensively, scoring rules should be established a priori, with a research or consultation group available to evaluate ambiguous nights (Acebo & LeBourgeois, 2006; Acebo, Sadeh, Seifer, et al., 1999; Meltzer, Montgomery-Downs, Insana, et al., 2012; Wolfson, Carskadon, Acebo et al., 2003).
In Part Four, Sleep Challenges, Problems, and Disorders, authors Brandy Roane and Daniel Taylor, Robert Auger and Stephanie Crowley, Anna Ivanenko and Kymberly Larson, Kristen Archbold, and Patrina Caldwell and Karen Waters discuss some of the common sleep problems that children, adolescents, and their families confront including insomnia, delayed sleep phase disorder, nightmares and parasomnias, sleep apnea, and nocturnal enuresis. Many such sleep problems receive the attention of pediatricians and increasingly more psychologists, and there are also numerous books available for parents and professionals (e.g., Ferber, 2006; Ivanenko, 2008; Mindell, 2005; Owens & Mindell, 2003/2010). Many problems of sleep in young children are resolved before school attendance, but these difficulties sometimes come to the attention of child clinical and school psychologists. Sleep disorders with substantial prevalence in adulthood, such as obstructive sleep apnea, insomnia, and restless legs syndrome are also prevalent in children. This section reviews the diagnostic and treatment outcome literature and provides suggestions for behavioral interventions that can be implemented by psychologists and other clinicians. (p. 5)
Part Five focuses on the Consequences of Insufficient Sleep, with chapters by Erika Bagley and Mona El-Sheikh; Victoria Molfese, Kathleen Moritz Rudasill and Dennis Molfese; Louise O’Brien; Chantelle Hart, Nicola Hawley, Elizabeth Kuhl and Elissa Jelalian; and Shelley Hershner. These chapters discuss the preponderance of evidence that insufficient sleep, inconsistent sleep-wake schedules, sleep problems, and poor sleep hygiene habits are associated with health and behavior problems including internalizing and externalizing behaviors, emotion dysregulation, hyperactivity, inattention, school adjustment, and ineffective cognitive skills in children and adolescents. Shelly Hershner emphasizes that inadequate and erratic sleep in adolescents and emerging adults can have substantial consequences—that is, “sleepy driver” and “fall asleep at the wheel” driving accidents. Some locations have regulated when young drivers can be on the road and include education materials on sleep and the consequences of sleep deprivation in drivers education programs (e.g., Curriculum Scope and Sequence Modules for Driver Education in Virginia, 2001; Driver Education Program, Massachusetts Department of Transportation, 2010). In many ways, this section is only the tip of the iceberg, as, in addition to the areas covered by these authors, research has demonstrated that insufficient, inconsistent, and disordered sleep has negative consequences for cognitive development, substance use and abuse, work-related accidents, immune system functioning, and a range of other health, behavioral, and cognitive factors.
Sleep Difficulties Associated with Developmental and Behavioral Risks are examined in Part Six. Authors Daphne Koinis Mitchell and Robin Everhart; Amanda Richdale, Penny Corkum and J. Aimee Coulombe; Alison Harvey, Candice Alfano, and Greg Clarke; and Richard Bootzin, Jennifer Cousins, Monica Kelly, and Sally Stevens examine children, adolescents, and emerging adults with asthma and allergies, developmental disabilities, attention deficit hyperactivity disorder, affective disorders, and struggles with substance abuse. A prevalence of comorbid sleep problems is not uncommon for children and adolescents with behavioral and emotional disorders (e.g., Quine, 2001; Redline, Tishler, Schluchter, et al., 1999; Snell, Adam, & Duncan, 2007; Stores & Wiggs, 2001; Wolfson & Armitage, 2009). Of course, psychologists regularly work with children with these difficulties, but they may be less familiar with the associated sleep problems and behavioral consequences. In some situations, intervening and treating the sleep problems might mitigate the presenting and often challenging behavioral difficulties.
The Oxford Handbook of Infant, Child, and Adolescent Sleep and Behavior concludes with, perhaps, the most important area, Part Seven: Prevention and Intervention. These final five chapters (authors Melissa Moore and Jodi Mindell; Rhoda Au, Erica Appleman and Karina Stavitsky; Reut Gruber, Evelyn Constantin, Jamie Cassoff, and Sonia Michaelson; Pamela Thatcher; and S. Justin Thomas, Kristin Avis, and Kenneth Lichstein) focus on interventions and preventive approaches for families with young children; systemic countermeasures such as delaying school start times; prevention strategies and social learning-based programs for elementary, middle, and high school students; and approaches for working with college students and emerging adults struggling with disordered sleep. For example, my research team’s Young Adolescent Sleep-Smart Pacesetter Program (funded by the National Institute of Child Health and Human Development) is evaluating the efficacy of a social learning–based, preventive intervention program designed to help early adolescents develop healthy sleep hygiene practices including decreasing caffeine use, obtaining adequate sleep, and maintaining consistent sleep schedules. Preliminary results suggest that the school-based Sleep-Smart program improved early adolescents’ sleep patterns, hygiene practices, and sleep competence (Johnson, Harkins, Marco, Ludden, & Wolfson, 2012). Sleep-Smart participants also evidenced fewer health and behavioral difficulties and better grades following the program, whereas their comparison peers’ behaviors remained the same during 7th grade.
The authors of this handbook have committed their academic and/or clinical careers to understanding the development of sleep patterns and the potential hurdles that prevent infants, children, and adolescents—along with their families—from obtaining sufficient and regular sleep. I am certain that they would agree with me and my coeditor, Hawley Montgomery-Downs, that high-quality, sound, and restorative sleep can improve our daily experiences, competence, and overall physical and emotional health. It is our hope that the research, guidance, and future directions discussed in each of the chapters in the The Oxford Handbook of Infant, Child, and Adolescent Sleep and Behavior will help psychologists and other behavioral scientists to understand and continue to study sleep and circadian rhythms in the context of psychological (p. 6) development and children’s health, and in the prevention and treatment of sleep and behavioral disorders. As I recall, at about age 9, my son exclaimed one night: “Just because you study sleep, doesn’t mean that I have to have a bedtime!” In looking back, I think he really meant to say: “Duh…you do not have to be a psychologist to know that a 9-year-old like me needs to get a good night’s sleep!”
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