Valérie Simard

Early maladaptive schemas and child and adult attachment: A 15‐year longitudinal study

OBJECTIVES To examine the relation between early maladaptive schemas (EMS), as defined in schema therapy, and both child and adult attachment. DESIGN A 15-year longitudinal design in which child attachment groups (secure, avoidant, ambivalent, and disorganized) were compared in early adulthood on their profile of scores across EMS domains. A similar strategy was used to examine EMS profiles as a function of adult attachment groups (secure, preoccupied, and fearful). METHODS Sixty participants, recruited from Montreal day-care centres, were assessed at 6 (Time 1) and 21 years of age (Time 2). Time 1 attachment was assessed using a separation-reunion procedure and Time 2 attachment, using the Experiences in Close Relationships questionnaire. EMS were evaluated with the Young Schema Questionnaire (Time 2). RESULTS There were more signs of EMS among young adults with either an insecure ambivalent child attachment, or an insecure preoccupied adult attachment style, compared to their secure peers. These differences were not specific to one domain of EMS; they were reported for various EMS. CONCLUSIONS The results suggest that specific elements of representational models are more likely to be related to the development of EMS: high anxiety over abandonment, negative self-view, and explicit manifestations of personal distress. Unmet childhood needs for secure attachment may lead to a large variety of EMS as defined in schema therapy.

Disturbed dreaming during the third trimester of pregnancy

OBJECTIVE The majority of women develop sleep impairments during pregnancy, but alterations in dream experiences remain poorly understood. This study aimed to assess prospectively and comparatively the recall of dreaming and of disturbed dreaming in late pregnancy. METHODS Fifty-seven nulliparous, third-trimester pregnant women (mean age±SD, 28.7±4.06 years) and 59 non-pregnant controls (mean age±SD, 26.8±4.21 years) completed demographics and psychological questionnaires. A 14-day prospective home log assessed sleep and dream characteristics and the Sleep Disorders Questionnaire measured retrospective dream and disturbed dream recall. RESULTS Even though pregnant and non-pregnant women showed similar prospective dream recall (P=0.47), pregnant women reported prospectively more bad dreams (P=0.004). More pregnant women (21%) than non-pregnant women (7%) reported a nightmare incidence exceeding moderately severe pathology (>1/week) (P=0.03). Pregnant women also reported overall lower sleep quality (P=0.007) and more night awakenings (P=0.003). Higher prospective recall of bad dreams (r = -0.40, P=0.002) and nightmares (r = -0.32, P=0.001) both correlated with lower sleep quality in pregnant women. CONCLUSIONS Late pregnancy is a period of markedly increased dysphoric dream imagery that may be a major contributor to impaired sleep at this time. Further polysomnographic assessments of pregnant women are needed to clarify relationships between sleep and disturbed dream production in this population.

Infant Attachment and Toddlers’ Sleep Assessed by Maternal Reports and Actigraphy: Different Measurement Methods Yield Different Relations

OBJECTIVE To investigate relations between childrens attachment and sleep, using objective and subjective sleep measures. Secondarily, to identify the most accurate actigraphy algorithm for toddlers. METHODS 55 mother-child dyads took part in the Strange Situation Procedure (18 months) to assess attachment. At 2 years, children wore an Actiwatch for a 72-hr period, and their mothers completed a sleep diary. RESULTS The high sensitivity (80) and smoothed actigraphy algorithms provided the most plausible sleep data. Maternal diaries yielded longer estimated sleep duration and shorter wake duration at night and showed poor agreement with actigraphy. More resistant attachment behavior was not associated with actigraphy-assessed sleep, but was associated with longer nocturnal wake duration as estimated by mothers, and with a reduced actigraphy-diary discrepancy. CONCLUSIONS Mothers of children with resistant attachment are more aware of their childs nocturnal awakenings. Researchers and clinicians should select the best sleep measurement method for their specific needs.

Maternal representations in the dreams of pregnant women: a prospective comparative study.

Dreams are thought to respond to self- and socially-relevant situations that evoke strong emotions and require rapid adaptation. First pregnancy is such a situation during which maternal mental representations (MMR) of the unborn baby, the self and significant others undergo remodeling. Some studies suggest that dreams during pregnancy contain more MMR and are more dysphoric, but such studies contain important methodological flaws. We assessed whether dreamed MMR, like waking MMR, change from the 7th month of pregnancy to birth, and whether pregnancy–related themes and non-pregnancy characteristics are also transformed. Sixty non-pregnant and 59 pregnant women (37 early and 22 late 3rd trimester) completed demographic and psychological questionnaires and 14-day home dream logs. Dream reports were blindly rated according to four dream categories: (1) Dreamed MMR, (2) Quality of baby/child representations, (3) Pregnancy-related themes, (4) Non-pregnancy characteristics. Controlling for age, relationship and employment status, education level and state anxiety, women in both pregnant groups reported more dreams depicting themselves as a mother or with babies/children than did non-pregnant women (all p = 0.006). Baby/child representations were less specific in the late 3rd than in the early 3rd trimester (p = 0.005) and than in non-pregnant women (p = 0.01). Pregnant groups also had more pregnancy, childbirth and fetus themes (all p = 0.01). Childbirth content was higher in late than in early 3rd trimester (p = 0.01). Pregnant groups had more morbid elements than did the non-pregnant group (all p < 0.05). Dreaming during pregnancy appears to reflect daytime processes of remodeling MMR of the woman as a mother and of her unborn baby, and parallels a decline in the quality of baby/child representations in the last stage of pregnancy. More frequent morbid content in late pregnancy suggests that the psychological challenges of pregnancy are reflected in a generally more dysphoric emotional tone in dream content.

Objective and subjective measures of sleep among preschoolers: Disentangling attachment security and dependency

Many scholars have proposed that parent-child attachment security should favor child sleep. Research has yet, however, to provide convincing support for this hypothesis. The current study used objective measures of sleep and attachment to assess the longitudinal links between mother-child attachment security and subsequent sleep, controlling for child dependency. Sixty-two middle-class families (30 girls) were met twice, when children were 15 months (Wave 1; W1) and 2 years of age (Wave 2; W2). At W1, mother-child attachment was assessed with the observer version of the Attachment Q-Sort. At W2, children wore an actigraph monitor for 72 hr. Results indicated that children more securely attached to their mothers subsequently slept more at night and had higher sleep efficiency, and these predictions were not confounded by child dependency. These findings suggest a unique role for secure attachment relationships in the development of young childrens sleep regulation, while addressing methodological issues that have long precluded consensus in this literature.

VIII. ATTACHMENT AND SLEEP AMONG TODDLERS: DISENTANGLING ATTACHMENT SECURITY AND DEPENDENCY

Many scholars have proposed that parent-child attachment security should favor child sleep. Research has yet, however, to provide convincing support for this hypothesis. The current study used objective measures of sleep and attachment to assess the longitudinal links between mother-child attachment security and subsequent sleep, controlling for child dependency. Sixty-two middle-class families (30 girls) were met twice, when children were 15 months (Wave 1; W1) and 2 years of age (Wave 2; W2). At W1, mother-child attachment was assessed with the observer version of the Attachment Q-Sort. At W2, children wore an actigraph monitor for 72 hr. Results indicated that children more securely attached to their mothers subsequently slept more at night and had higher sleep efficiency, and these predictions were not confounded by child dependency. These findings suggest a unique role for secure attachment relationships in the development of young childrens sleep regulation, while addressing methodological issues that have long precluded consensus in this literature.

Sleeping Toward Behavioral Regulation: Relations Between Sleep and Externalizing Symptoms in Toddlers and Preschoolers

The aim of this study was to investigate the concurrent and longitudinal relations between sleep and externalizing symptoms among young children. Sixty-four families (mostly Caucasian; 36 boys) were met twice, when children were 2 (T1) and 4 years of age (T2). At T1, children wore an actigraph monitor for a 72-hr period, and both mothers and fathers completed the Child Behavior Checklist. At T2, both parents as well as the daycare educator filled the Child Behavior Checklist. At T1, longer sleep duration and higher sleep efficiency were associated with fewer externalizing symptoms as assessed by mothers. Results also indicated that higher sleep efficiency at T1 was related to fewer parent-reported externalizing symptoms at T2 (while controlling for prior externalizing symptoms). Relations between sleep efficiency at T1 and externalizing symptoms as assessed by mothers at T1 and by fathers at T2 were moderated by child sex, such that links were significant among boys only. Results pertaining to educators’ reports were inconclusive. The current study highlights the importance of rapidly treating sleep difficulties, which are associated with persistent behavioral maladjustment, perhaps especially for boys.

Investigating the Convergence between Actigraphy, Maternal Sleep Diaries, and the Child Behavior Checklist as Measures of Sleep in Toddlers

The current study examined associations among actigraphy, maternal sleep diaries, and the parent-completed child behavior checklist (CBCL) sleep items. These items are often used as a sleep measure despite their unclear validity with young children. Eighty middle class families (39 girls) drawn from a community sample participated. Children (M = 25.34 months, SD = 1.04) wore an actigraph monitor (Mini-Mitter® Actiwatch Actigraph, Respironics) for a 72-h period, and mothers completed a sleep diary during the same period. Eighty-nine percent of the mothers and 75% of the fathers also filled out the CBCL (1.5–5). Mother and father CBCL scores were highly correlated. Overall, good correspondence was found between the CBCL filled out by mothers and sleep efficiency and duration derived from maternal sleep diaries (r between −0.39 and −0.25, p ≤ 0.05). Good correspondence was also found between the CBCL filled out by fathers and sleep efficiency as derived from maternal sleep diaries (r between −0.39 and −0.24, p ≤ 0.05), but not with sleep duration (all results were non-significant). Very few correlations between actigraphy and the CLBL scores reached statistical significance. The Bland and Altman method revealed that sleep diaries and actigraphy showed poor agreement with one another when assessing sleep duration and sleep efficiency. However, diary- and actigraphy-derived sleep durations were significantly correlated. Consistent with findings among older groups of children, this study suggests that the CBCL sleep items, sleep diaries, and actigraphy tap into quite different aspects of sleep among toddlers. The choice of which measures to use should be based on the exact aspects of sleep that one aims to assess. Overall, despite its frequent use, the composite sleep score of the CBCL shows poor links to objective measures of sleep duration and sleep efficiency.

Sleep and attachment in early childhood: a series of meta-analyses

ABSTRACT Empirical findings regarding the association between child attachment and sleep have been inconsistent. The objectives of this series of meta-analyses were to assess the size of the association between child sleep and attachment and to examine whether study methodology (attachment measure, sleep measure) and age moderate this association. Sixteen studies (2783 children aged from 6 to 38 months) were included. Significant associations were found between attachment security and sleep efficiency (r = .18) and attachment resistance and sleep problems (r = .18). There were significant moderator effects of sleep measure and age of the child, with the size of the association between sleep and attachment security increasing with age (R2 analog = .67). Inconsistent findings are likely due to inter-study variabilities in methodology and to a developmental effect on the sleep-attachment association.

Breastfeeding, maternal depressive mood and room sharing as predictors of sleep fragmentation in 12-week-old infants: a longitudinal study

Sleep fragmentation in infancy can burden a family by disrupting the sleep of all its members. However, there has been no longitudinal prospective investigation of the determinants of infant sleep fragmentation. We undertook such an investigation. New mothers (N = 106) completed questionnaires and were administered structured telephone interviews at three, six and 12 weeks postpartum. Pre- and postnatal maternal adjustment and sleep-related parental practices were evaluated as potential predictors of infants’ sleep fragmentation. Risk factors for infants sleeping less than six consecutive hours per night at 12 weeks were found to be mother’s depressed mood (OR = 1.55, p < .01), breastfeeding (OR = 6.40, p < .01) and room sharing (OR = 2.91, p < .05). The mother’s depressed mood and breastfeeding were also related to poor sleep consolidation when the latter was assessed as a continuous outcome (p < .01). This study identifies factors to target in sleep-focused interventions in families where the child’s sleep has become a problem.