Alison L. Miller

Acute sleep restriction effects on emotion responses in 30- to 36-month-old children

Early childhood is a period of dramatic change in sleep and emotion processing, as well as a time when disturbance in both domains are first detected. Although sleep is recognized as central in emotion processing and psychopathology, the great majority of experimental data have been collected in adults. We examined the effects of acute sleep restriction (nap deprivation) on toddlers’ emotion expression. Ten healthy children (seven females; 30–36 months old) followed a strict sleep schedule (≥12.5 h time in bed per 24‐h) for 5 days, before each of two randomly assigned afternoon emotion assessments following Nap and No‐Nap conditions (resulting in an 11‐day protocol). Children viewed emotion‐eliciting pictures (five positive, three neutral, three negative) and completed puzzles (one solvable, one unsolvable). Children’s faces were video‐recorded, and emotion displays were coded. When sleep restricted, children displayed less confusion in response to neutral pictures, more negativity to neutral and negative pictures, and less positivity to positive pictures. Sleep restriction also resulted in a 34% reduction in positive emotion responses (solvable puzzle), as well as a 31% increase in negative emotion responses and a 39% decrease in confused responses (unsolvable puzzle). These findings suggest sleep is a key factor in how young children respond to their world. When sleep restricted, toddlers are neither able to take full advantage of positive experiences nor are they as adaptive in challenging contexts. If insufficient sleep consistently ‘taxes’ young children’s emotion responses, they may not manage emotion regulation challenges effectively, potentially placing them at risk for future emotional/behavioral problems.

Showing and telling about emotions: Interrelations between facets of emotional competence and associations with classroom adjustment in Head Start preschoolers

In this study of low income preschoolers (N =  60), we examined relations between three facets of emotional competence: emotion knowledge, level of negative emotion expression, and emotion regulation; and their associations with indicators of classroom adjustment. Emotion knowledge was positively related to positive emotion regulation but was not related to negative emotion expression or negative dysregulation. Negative emotion expression related to emotion regulation variables in expected directions. Negative emotion expression was associated with aggression and social skills after covarying verbal ability, age, and emotion knowledge. Negative dysregulation was related in expected directions to aggression, anxiety, and social skills after covarying verbal ability, age, emotion knowledge, and negative emotion expression. Positive emotion regulation was related negatively to anxiety and positively to social skills after covarying all other variables in the model. Results are discussed with regard to using the emotional competence domain to understand how emotion processing relates to early childhood adjustment.

Adolescent Resilience: Promotive Factors That Inform Prevention

Resilience theory provides a framework for studying and understanding how some youths overcome risk exposure and guides the development of interventions for prevention using a strengths-based approach. In this article, we describe basic concepts of the theory, such as promotive factors, and distinguish assets and resources that help youths overcome the negative effects of risk exposure. We also present three models of resilience theory-compensatory, protective, and challenge-and review empirical research on three promotive factors-ethnic identity, social support, and prosocial involvement-that include individual, family, and community levels of analysis and have modifiable qualities for informing interventions. Finally, we present examples of how research findings from the three promotive factors can be translated into interventions to enhance youth development.

Associations between maternal depressive symptoms and child feeding practices in a cross-sectional study of low-income mothers and their young children

BackgroundMaternal depression may influence feeding practices important in determining child eating behaviors and weight. However, the association between maternal depressive symptoms and feeding practices has been inconsistent, and most prior studies used self-report questionnaires alone to characterize feeding. The purpose of this study was to identify feeding practices associated with maternal depressive symptoms using multiple methodologies, and to test the hypothesis that maternal depressive symptoms are associated with less responsive feeding practices.MethodsIn this cross-sectional, observational study, participants (n = 295) included low-income mothers and their 4- to 8-year-old children. Maternal feeding practices were assessed via interviewer-administered questionnaires, semi-structured narrative interviews, and videotaped observations in home and laboratory settings. Maternal depressive symptoms were measured using the Center for Epidemiologic Studies-Depression scale (CES-D). Regression analyses examined associations between elevated depressive symptoms (CES-D score ≥16) and measures of maternal feeding practices, adjusting for: child sex, food fussiness, number of older siblings; and maternal age, body mass index (BMI), education, race/ethnicity, single parent status, perceived child weight, and concern about child weight.ResultsThirty-one percent of mothers reported depressive symptoms above the screening cutoff. Mothers with elevated depressive symptoms reported more pressuring of children to eat (β = 0.29; 95% Confidence Interval (CI): 0.03, 0.54) and more overall demandingness (β = 0.16; 95% CI: 0.03, 0.29), and expressed lower authority in child feeding during semi-structured narrative interview (Odds Ratio (OR) for low authority: 2.82; 95% CI: 1.55, 5.12). In homes of mothers with elevated depressive symptoms, the television was more likely audible during meals (OR: 1.91; 95% CI: 1.05, 3.48) and mothers were less likely to eat with children (OR: 0.48; 95% CI: 0.27, 0.85). There were no associations between maternal depressive symptoms and encouragement or discouragement of food in laboratory eating interactions.ConclusionsMothers with elevated depressive symptoms demonstrated less responsive feeding practices than mothers with lower levels of depressive symptoms. These results suggest that screening for maternal depressive symptoms may be useful when counseling on healthy child feeding practices. Given inconsistencies across methodologies, future research should include multiple methods of characterizing feeding practices and direct comparisons of different methodologies.

Enhancing self-regulation as a strategy for obesity prevention in Head Start preschoolers: the growing healthy study.

BackgroundNearly one in five 4-year-old children in the United States are obese, with low-income children almost twice as likely to be obese as their middle/upper-income peers. Few obesity prevention programs for low-income preschoolers and their parents have been rigorously tested, and effects are modest. We are testing a novel obesity prevention program for low-income preschoolers built on the premise that children who are better able to self-regulate in the face of psychosocial stressors may be less likely to eat impulsively in response to stress. Enhancing behavioral self-regulation skills in low-income children may be a unique and important intervention approach to prevent childhood obesity.Methods/designThe Growing Healthy study is a randomized controlled trial evaluating two obesity prevention interventions in 600 low-income preschoolers attending Head Start, a federally-funded preschool program for low-income children. Interventions are delivered by community-based, nutrition-education staff partnering with Head Start. The first intervention (n = 200), Preschool Obesity Prevention Series (POPS), addresses evidence-based obesity prevention behaviors for preschool-aged children and their parents. The second intervention (n = 200) comprises POPS in combination with the Incredible Years Series (IYS), an evidence-based approach to improving self-regulation among preschool-aged children. The comparison condition (n = 200) is Usual Head Start Exposure. We hypothesize that POPS will yield positive effects compared to Usual Head Start, and that the combined intervention (POPS + IYS) addressing behaviors well-known to be associated with obesity risk, as well as self-regulatory capacity, will be most effective in preventing excessive increases in child adiposity indices (body mass index, skinfold thickness). We will evaluate additional child outcomes using parent and teacher reports and direct assessments of food-related self-regulation. We will also gather process data on intervention implementation, including fidelity, attendance, engagement, and satisfaction.DiscussionThe Growing Healthy study will shed light on associations between self-regulation skills and obesity risk in low-income preschoolers. If the project is effective in preventing obesity, results can also provide critical insights into how best to deliver obesity prevention programming to parents and children in a community-based setting like Head Start in order to promote better health among at-risk children.Trial registration numberClinicaltrials.gov Identifier: NCT01398358

Obesity-associated biomarkers and executive function in children

There is a growing focus on links between obesity and cognitive decline in adulthood, including Alzheimer’s disease. It is also increasingly recognized that obesity in youth is associated with poorer cognitive function, specifically executive functioning skills such as inhibitory control and working memory, which are critical for academic achievement. Emerging literature provides evidence for possible biological mechanisms driven by obesity; obesity-associated biomarkers such as adipokines, obesity-associated inflammatory cytokines, and obesity-associated gut hormones have been associated with learning, memory, and general cognitive function. To date, examination of obesity-associated biology with brain function has primarily occurred in animal models. The few studies examining such biologically mediated pathways in adult humans have corroborated the animal data, but this body of work has gone relatively unrecognized by the pediatric literature. Despite the fact that differences in these biomarkers have been found in association with obesity in children, the possibility that obesity-related biology could affect brain development in children has not been actively considered. We review obesity-associated biomarkers that have shown associations with neurocognitive skills, specifically executive functioning skills, which have far-reaching implications for child development. Understanding such gut–brain associations early in the lifespan may yield unique intervention implications.

Blunted cortisol response to stress is associated with higher body mass index in low-income preschool-aged children.

No known studies have tested the hypothesis that a blunted pattern of cortisol reactivity to stress, which is often found following exposure to chronic life stressors, is associated with a higher body mass index (BMI) in very young children. Low-income children (n=218, mean age 56.6 (range: 38.1-78.5; SD 7.0) months, 49.1% male, 56.4% white, 16.1% black, 11.5% Hispanic/Latino) participated in a series of behavioral tasks designed to elicit stress. Cortisol was sampled in saliva 5 times during the protocol, and area under the curve (AUC), representing total cortisol output during stress elicitation, was calculated. Children were weighed and height measured and body mass index (BMI) z-score was calculated. Linear regression was used to evaluate the association between cortisol AUC and BMI z-score, controlling for child age, sex, and race/ethnicity (non-Hispanic white vs. not); primary caregiver weight status (overweight, defined as BMI ≥ 25 vs. not); and family income-to-needs ratio. Mean child BMI z-score was 0.88 (SD=1.03). Mean cortisol AUC was 6.11 μg/dL/min (SD=10.44). In the fully adjusted model, for each 1-standard deviation unit decrease in cortisol AUC, the childs BMI z-score increased by 0.17 (SE 0.07) standard deviation units (p<0.02). A blunted cortisol response to stress, as is often seen following chronic stress exposure, is associated with increased BMI z-score in very young children. Further work is needed to understand how associations between stress, cortisol, and elevated body mass index may develop very early in the lifespan.

Toddler's self-regulation strategies in a challenge context are nap-dependent.

Early childhood represents a time of developmental changes in both sleep and self‐regulation, a construct reflecting the ability to control ones behaviour, attention and emotions when challenged. Links between sleep and self‐regulation processes have been proposed, but experimental evidence with young children is lacking. In the current study, we tested the effects of acute sleep restriction (nap deprivation) on toddlers’ self‐regulation. Healthy children (n = 12; four males; aged 30–36 months (33.9 ± 1.7)) slept on a strict schedule (verified with actigraphy and sleep diaries) for 5 days before each of two afternoon assessments following a nap and a no‐nap condition (~11‐day protocol). Children were videotaped while attempting an unsolvable puzzle, and 10 mutually exclusive self‐regulation strategies were later coded. On average, children lost ~90 min of sleep on the no‐nap versus the nap day. Nap deprivation resulted in moderate‐to‐large effects on self‐regulation strategies, with decreases in scepticism (d = 0.77; 7% change), negative self‐appraisal (d = 0.92; 5% change) and increases in physical self‐soothing (d = 0.68; 10% change), focus on the puzzle piece that would not fit (perseveration; d = 0.50; 9% change) and insistence on completing the unsolvable puzzle (d = 0.91; 10% change). Results suggest that sleep serves an important role in the way that toddlers respond to challenging events in their daily lives. After losing daytime sleep, toddlers were less able to engage effectively in a difficult task and reverted to less mature self‐regulation strategies than when they were well rested. Over time, chronically missed sleep may impair young childrens self‐regulation abilities, resulting in risk for social–emotional, behavioural and school problems.

Relations between Temperament and Theory of Mind Development in the United States and China: Biological and Behavioral Correlates of Preschoolers' False-Belief Understanding.

The emotional reactivity hypothesis holds that, over the course of phylogeny, the selection of animals with less reactive temperaments supported the development of sophisticated social-cognitive skills in several species, including humans (Hare, 2007). In the ontogenetic human case, an emotional reactivity hypothesis predicts that children with less reactive temperaments will reach certain milestones in theory-of-mind (ToM) development more quickly. We examined relations between temperament and false-belief understanding in 102 preschool-age children from China and the United States. Temperament was measured via parental ratings of behavior as well as with physiological measures of childrens reactivity (hypothalamic-pituitary-adrenocortical axis reactivity gauged via salivary cortisol). In accord with an emotional reactivity hypothesis, children with certain reactive temperaments--specifically, those who were more aggressive and those who were both socially withdrawn and physiologically reactive--evidenced poorer social-cognition. However, our findings also force amendment to the ontogenetic emotional reactivity hypothesis. For the majority of children in both countries, physiological reactivity predicted more advanced ToM, perhaps by facilitating social engagement and attention to social stimuli. Moreover, children who were withdrawn from social interaction yet nonreactive, especially Chinese children of this temperament, evidenced advanced ToM. Thus, some forms of social disengagement may foster social-cognitive development in certain sociocultural contexts.

Sleep timing moderates the concurrent sleep duration-body mass index association in low-income preschool-age children.

OBJECTIVE To test the independent main and moderating effects of sleep timing on body mass index (BMI) in low-income preschool-age children (M = 4.11 years, SD = 0.54). METHODS Parents reported demographics and childrens sleep concurrently, and a subset of children was followed longitudinally. Child height and weight were measured and BMI z score (BMIz) calculated. Regression analysis evaluated main effects of sleep timing (bedtime, weekday-to-weekend schedule shifting, napping) on concurrent BMIz and future rate of change, and their moderating effects on the sleep duration-BMIz association. RESULTS Of 366 children (longitudinal subsample = 273), 50% were boys, 57% white, and 37% overweight or obese. Nocturnal sleep duration predicted concurrent BMIz, but not rate of change in BMIz over time. Bedtime was a moderator; the sleep duration-BMIz association was present only among children with bedtimes after 9 pm (β = -0.44; 95% confidence interval -0.69, -0.18). Schedule shifting was a moderator; the association between greater nocturnal sleep duration and lesser rate of future BMIz increase was present only among children with the most consistent sleep schedules (<45-minute delay in weekend bedtime: β = -0.12; 95% confidence interval -0.23, -0.01). Daytime napping did not moderate the nocturnal sleep duration-BMIz association. Covariates (sleep-disordered breathing, soda consumption, home chaos) did not explain these associations. CONCLUSIONS Among low-income preschoolers, sleep timing moderated the nocturnal sleep duration-BMIz association. Understanding how sleep timing and sleep duration relate to childhood obesity is important for prevention efforts.