Stephanie Stadelmann

Sleep actigraphy pattern and behavioral/emotional difficulties in kindergarten children : association with hypothalamic-pituitary-adrenocortical (HPA) activity

BACKGROUND Various studies of adult endocrinology and sleep show close connections between poor sleep quality, deterioration of the HPA axis and negative psychological characteristics. However, the extent to which these associations may have already emerged and developed in childhood remains unclear. METHODS A total of 82 preschoolers (age 4.91+/-0.48) underwent activity monitoring for seven consecutive days and nights, wearing a digital movement-measuring instrument. Additionally, on the first and on the last morning of sleep registration, the activity of the HPA axis was assessed via the amount of cortisol in the saliva. Psychological and behavioral assessments were also made. RESULTS Three sub-groups of good (22%), normal (58.5%) and poor (19.5%) sleepers were distinguished. Poor sleep patterns were associated with higher HPA activity and with behavioral/emotional difficulties. CONCLUSIONS The interplay between unfavorable sleep patterns, deterioration of the HPA axis and behavioral/emotional difficulties is already apparent in pre-school children.

Pathways of behavioural and emotional symptoms in kindergarten children: What is the role of pro-social behaviour?

The study investigated the predictive value of pro-social behaviour for developmental pathways of behavioural and emotional problems at kindergarten age. One hundred and sixty children participated in the study at the ages of 5 and 6. Teachers and parents completed the Strengths and Difficulties Questionnaire; children completed the Berkeley Puppet Interview at both assessment points. Single-informant data were aggregated to enhance the reliability and validity of data. Gender and parental educational status were controlled.Symptoms (conduct problems, hyperactivity and emotional symptoms) and pro-social behaviour were moderately stable over time. Compared to girls, boys showed higher levels and increases of conduct problems and hyperactivity and lower levels of pro-social behaviour. Lower parental educational level was associated with higher levels and increases in hyperactivity. Although pro-social behaviour was cross-sectionally associated with behavioural and emotional symptoms, pro-social behaviour did not predict changes in conduct problems or hyperactivity over time. However, children with above average emotional symptoms and above average pro-social behaviour at Age_5 showed the highest level of emotional symptoms at Age_6. The results indicate that low levels of pro-social behaviour are associated with children’s externalising behaviour problems, but that for children with high levels of emotional symptoms, higher levels of pro-social behaviour should also be considered as a risk factor.In sum, our results suggest mainly homotypic pathways of internalising and externalising symptoms across kindergarten age, but indicate that the assessment of pro-social behaviour yields additional information regarding the developmental pathways of emotional symptoms.

In pre-school children, sleep objectively assessed via actigraphy remains stable over 12 months and is related to psychological functioning, but not to cortisol secretion

STUDY OBJECTIVES Cross-sectional studies provide evidence that in pre-schoolers poor sleep is by this age already associated with both poor psychological functioning and an increased cortisol secretion. However, long-term studies on the stability of sleep in pre-schoolers are scarce. The aim of the present study was therefore to investigate objectively assessed sleep in pre-schoolers longitudinally, and to predict sleep, psychological functioning and cortisol secretion prospectively as a function of sleep 12 months earlier. METHOD A total of 58 pre-schoolers (mean age: 5.43 years; 47% females) were re-assessed 12 months later (mean age: 6.4 years). Sleep-EEG recordings were performed, saliva cortisol was analysed, and parents and experts rated childrens psychological functioning. RESULTS Longitudinally, poor objective sleep at age 5.4 years was associated with poor objective sleep and psychological difficulties but not cortisol secretion 12 months later. At age 6.4 years, poor sleep was concurrently associated with greater psychological difficulties and increased cortisol secretion. CONCLUSION In pre-schoolers, poor sleep objectively assessed at the age of 5.4 years was associated with poor sleep and psychological difficulties one year later. Data indicate that in pre-schoolers, sleep remains stable over a 12-months-period. Pre-schoolers with poor sleep appear to be at risk for developing further psychological difficulties.

Story stem narratives of clinical and normal kindergarten children: Are content and performance associated with children's social competence?

Abstract This study examined whether content and performance in story stem narratives were associated with childrens social competence, and whether childrens symptom levels moderated these associations. Five-year-old children from a clinically enriched Swiss sample completed eight stories (N = 187). Teachers rated childrens social competence. Parents and teachers rated behavioral/emotional symptoms that were used to categorize children into clinical (n = 80), borderline (n = 31), and normal (n = 74). Controlling for gender and verbal competence, no differences were found in story responses between normal and clinical children. However, pro-social/moral and disciplinary themes, and coherence and quality of narration were significantly associated with childrens social competence. The associations between narratives and social competence were prominent in the clinical children, suggesting that narrative assessments may help to identify resources on which psychotherapeutic approaches can build.

Pre-schoolers suffering from psychiatric disorders show increased cortisol secretion and poor sleep compared to healthy controls

BACKGROUND Various studies of child cortisol secretion and sleep show a close association between poor sleep, deterioration of the HPA axis and unfavorable psychological functioning. However, there is little evidence as to whether these associations are clearly present in pre-school children suffering from psychiatric disorders. METHOD A total of 30 pre-schoolers suffering from psychiatric disorders (anxiety, adjustment disorders, emotional and attachment disorder; hyperactivity or oppositional disorder) and 35 healthy controls took part in the study. Saliva cortisol secretion was assessed both at baseline and under challenge conditions. Sleep was assessed via activity monitoring for seven consecutive days and nights, using a digital movement-measuring instrument. Parents and teachers completed questionnaires assessing childrens cognitive, emotional and social functioning. The Berkeley Puppet Interview provided child-based reports of cognitive-emotional processes. RESULTS Compared to healthy controls, children suffering from psychiatric disorders had much higher cortisol secretion both at baseline and under challenge conditions. Sleep was also more disturbed, and parents and teachers rated children suffering from psychiatric disorders as cognitively, emotionally and behaviorally more impaired, relative to healthy controls. Children with psychiatric disorders reported being more bullied and victimized. CONCLUSIONS In five-year old children the presence of psychiatric disorders is reflected not only at psychological, social and behavioral, but also at neuroendocrine and sleep-related levels. It is likely that these children remain at increased risk for suffering from psychiatric difficulties later in life.

Does objectively assessed sleep at five years predict sleep and psychological functioning at 14 years? : Hmm, yes and no!

BACKGROUND We tested the hypothesis that objectively assessed sleep at kindergarten level predicts sleep and psychological functioning in adolescence. METHOD Thirty-seven adolescents aged 14 years (SD = 1.3), of 67 participants assessed as preschoolers, took part in a follow-up study nine years later. Participants completed a series of questionnaires related to sleep and psychological functioning. Sleep-EEG clusters of poor, normal and good sleepers assessed as children nine years earlier were used as predictors for subjective sleep and psychological functioning in adolescence. RESULTS At the age of 14, those who were normal and good sleepers rather than poor sleepers at the age of five had more positive psychological functioning on dimensions including mental toughness, peer relationship, self-esteem, and perceived stress, but did not differ in current sleep patterns. CONCLUSIONS Objectively assessed sleep patterns at the age of five are predictive of aspects of psychological functioning during adolescence.

The interaction of social risk factors and HPA axis dysregulation in predicting emotional symptoms of five- and six-year-old children

OBJECTIVE We examined the links of social relational (family environment and peer victimization) and neuroendocrinological (HPA axis dysregulation) risk factors to childrens emotional symptoms. We placed special emphasis on the joint effects of these risk factors with respect to the emergence and course of the emotional symptoms. METHODS One hundred and sixty-six children were interviewed (Berkeley Puppet Interview) at age 5 and 6. Teachers and parents completed the Strengths and Difficulties Questionnaire. Parents completed the Family Environment Scales. Peer victimization was assessed by teacher and child reports. Childrens saliva cortisol was measured before and after a highly structured story completion task which targeted their cognitive emotional representations of family conflicts. RESULTS In the cross-sectional analyses, negative family environment, peer victimization, and cortisol increase during the story completion task independently contributed to the variance of emotional symptoms. There was a significant interaction effect between family environment and cortisol increase: those six-year-olds who had experienced an unfavorable family environment only showed high levels of emotional symptoms if they exhibited a cortisol increase during the story completion task. In the longitudinal analysis, peer victimization at age 5 predicted an increase of emotional symptoms at age 6, but only for those children who exhibited a blunted cortisol response a year earlier. CONCLUSIONS Negative family environment and peer victimization proved to be independently associated with emotional symptoms. HPA axis reactivity differentially moderated these associations. Therapeutic strategies should take the interaction between negative relational experiences and biological susceptibility to stress into account.

Maternal stress and internalizing symptoms in preschoolers: the moderating role of narrative coherence.

In the present study, we examined whether maternal psychosocial stress and childrens coherence in story-stem narratives are associated with preschool childrens internalizing symptoms and disorders, and whether narrative coherence moderates the association between maternal stress and childrens internalizing symptoms and disorders. The sample consists of 236 preschool children (129 girls, 107 boys; Mage = 5.15 years) and their mothers. Mothers completed questionnaires on their psychosocial stress burden and on child symptoms. A diagnostic interview (the Preschool Age Psychiatric Assessment; Egger & Angold, 2004) was conducted with one of the parents to assess childrens psychiatric diagnoses. Children completed 8 story stems of the MacArthur Story Stem Battery (Bretherton & Oppenheim, 2003). Story-stem narratives were coded for narrative coherence. Multivariate analyses were controlled for childrens age, gender, verbal performance, and externalizing symptoms. Results showed that maternal psychosocial stress was significantly associated with child internalizing symptoms and disorders. Neither maternal stress nor childrens internalizing symptoms or disorders were associated with narrative coherence. However, narrative coherence moderated the association between maternal stress and child internalizing symptoms. For children with more incoherent narratives, the association between maternal psychosocial stress and childrens internalizing symptoms was significantly stronger than for children with more coherent narratives. The moderation effect of narrative coherence concerning childrens internalizing disorders was found not to be significant. Our findings indicate that preschool childrens cognitive-emotional organization in dealing with relational conflict themes seems to buffer their mental health when exposed to adverse circumstances in their everyday family life.

The hyporeactivity of salivary cortisol at stress test (TSST-C) in children with internalizing or externalizing disorders is contrastively associated with α-amylase

BACKGROUND Stress biomarkers of the autonomic nervous system and hypothalamic-pituitary-adrenal axis (HPA-axis) can be measured via alpha-amylase (AA) and cortisol and cortisone in saliva. Objectives were to determine 1) the response patterns of cortisol, cortisone, and AA under both circadian conditions and the Trier Social Stress Test for Children (TSST-C), 2) which reactivity index is most suitable to differentiate internalizing or externalizing disorders from controls, and to explore 3) the interaction between AA and cortisol in the presence of internalizing or externalizing disorders. METHODS Saliva samples (n = 2893) from children with internalizing (n = 55) or externalizing disorders (n = 33) and healthy children (n = 81) were analyzed for cortisol, cortisone, and AA under circadian conditions and TSST-C. RESULTS Circadian rhythm of three biomarkers did not differ between diagnostic groups. Age and gender were significant predictors for cortisol and awakening time influenced all three biomarkers significantly. TSST-C responses appeared sequentially in the order of AA, cortisol, and cortisone. Trajectories of cortisol and cortisone responses, not in AA, were significantly lower in children with internalizing or externalizing disorders than in healthy children. Cortisol percentage increase appeared to be the most suitable reactivity index to detect the difference between the diagnostic groups. Internalizing disorders had a negative association between AA decrease and cortisol increase (β = -.199, p < .05, R(2) = .304). Externalizing disorders had a positive association between AA baseline and cortisol increase (β = .229, p < .05, R(2) = .304). CONCLUSION An altered HPA-axis response during stress might result from chronic allostatic load in internalizing disorders and underaroused stress response system in externalizing disorders.

Elterliche psychische Belastung, konflikthafte Paarbeziehung und Verhaltensregulation dreijähriger Kinder

Zusammenfassung. Anhand einer Stichprobe von 69 Familien mit Kindern im Alter von 3 bis 3.5 Jahren wurde die Bedeutung mutterlicher und vaterlicher psychischer Belastung und konflikthafter Paarbeziehung der Eltern fur die kindliche Verhaltensregulation uberpruft. Das elterliche Interaktionsverhalten mit dem Kind wurde als mogliche Vermittlungsvariable einbezogen. Die Verhaltensregulation des Kindes wurde mittels eines Elterninterviews (RABI) und eines Elternfragebogens (CBCL/2 - 3) erhoben. Zur Erfassung der psychischen Belastung der Eltern und der Qualitat der Paarbeziehung wurden Fragebogen verwendet (SCL-90-R, PFB). Die Einschatzung des elterlichen Interaktionsverhaltens beruht auf einer Eltern-Kind-Spielsequenz (FEAS). Unsere Resultate erbrachten deutliche Zusammenhange zwischen der mutterlichen psychischen Belastung sowie der konflikthaften Paarbeziehung und der Verhaltensregulation der dreijahrigen Kinder, sowohl bezuglich der sozialen Kompetenz als auch bezuglich der Verhaltensprobleme. Das elterli...