Evaluating Sleep in Autism Using CSHQ and CSHQ-Autism - A Perspective Through the Cultural Lens

The Child Sleep Hygiene Questionnaire (CSHQ) and its adapted version for autistic children, known as CSHQ-Autism, have gained recognition as essential tools for studying pediatric sleep patterns. 67 autistic children were evaluated using these questionnaires. 52 children screened positive on the CSHQ while 18 were screened positive on the CSHQ-Autism. Notably, both tools showed elevated ratings in the domains of sleep anxiety and co-sleeping, which may hinder their ability to accurately distinguish sleep disturbances. However, the prevalence of sleep anxiety/co-sleeping in Indian culture was found to be linked to more severe sleep disorders, while also serving as a protective factor against separation anxiety and sudden infant death syndrome (SIDS). Therefore, while the CSHQ and CSHQ-Autism serve as valuable assessment tools, their scores may be inflated by ingrained cultural norms in the Indian context.

Relationship Between Feeding to Sleep During Infancy and Subsequent Childhood Disease Burden

OBJECTIVE

To investigate the association of feeding to sleep during infancy and subsequent childhood health burdens.

STUDY DESIGN

Information was collected from the parents of children who participated in the national health screening survey when the child was 9-12 months old. The exposure group included participants who were fed to sleep. The primary outcome was all-cause hospital admission (inpatient care, intensive care unit [ICU] admission, or general anesthesia) after age 24 months. Secondary outcomes were subsequent childhood diseases (ie, adenoidectomy and/or tonsillectomy, nasal polyps, allergic rhinitis, acute otitis media, asthma, pneumonia, and aspiration pneumonia), and growth status, as measured by weight-to-age and height-to-age z-scores.

RESULTS

The study cohort consisted of 224 075 children who participated in the health screening program, 29 392 of whom (13.1%; 51% males) were fed to sleep. Exposure was associated with an increased risk of all-cause hospitalization after age 24 months (hazard ratio [HR], 1.05; 95% CI, 1.03-1.07), but not with admission to an ICU or receipt of general anesthesia. This also was related to adenoidectomy and/or tonsillectomy (HR, 1.08; 95% CI, 1.01-1.15), dental caries (HR, 1.32; 95% CI, 1.23-1.40), asthma (HR, 1.14; 95% CI, 1.14-1.24), pneumonia (HR, 1.10; 95% CI, 1.07-1.13), overweight (HR, 1.06; 95% CI, 1.03-1.09), and obesity (HR, 1.11; 95% CI, 1.06-1.16).

CONCLUSIONS

Several adverse health outcomes are related to feeding to sleep during early childhood.

Survey of Korean daycare personnel on safe sleep practices related to sudden unexplained infant death: a cross-sectional exploratory study

PURPOSE

Safe sleep practices (SSP) are among the main strategies to reduce sleep-related sudden unexplained infant death (SUID). Daycare personnel must be knowledgeable and trained in SSP related to SUID. This study explored the experience, knowledge, and confidence regarding SSP associated with SUID of daycare personnel.

METHODS

A cross-sectional survey was conducted with 395 staff members at 61 daycare centers to measure their experience related to SSP (10 items), related to sleep position and location, bedding materials, and other topics; knowledge of SSP (18 items); and confidence in SSP (1 item) related to SUID.

RESULTS

A substantial proportion (23.6%) of respondents used the lateral or prone positions for infant sleep. On average, 4.5 bedding materials were used for infant sleep. Participants showed a lack of knowledge about SSP as indicated by a 56.6% knowledge of SSP related to SUID correct answer rate. Personnel who received SUID education were more knowledgeable and had more confidence regarding SSP than those who did not. More knowledge and confidence related to SSP were associated with better adherence to SSP.

CONCLUSION

Standard SSP guidelines should be developed based on South Korea's culture of childcare for educating both childcare professionals and parents at home.

Sleep and social-emotional problems in preschool-age children with developmental delay

Sleep problems and social-emotional (SE) problems are common in preschooler children and may be affected by culture. However, little is known about the link between sleep and social-emotional problems in non-Western countries. This study aims to compare sleep problems and their association with SE problems in Turkish children with either typical development (TD) or neurodevelopmental delay (NDD). In this case-control study, children with NDD (n = 126) and children with TD (n = 102) were included. Parents completed the Children's Sleep Habits Questionnaire (CSHQ), and the Ages and Stages Questionnaire: Social-Emotional (ASQ:SE). More than half of the TD and NDD groups had sleep problems when assessed by CSHQ (54.4%, 72.2%, respectively). The correlation between CSHQ and ASQ:SE scores in the NDD and TD groups was r = 0.44 and r = 0.352, respectively (both p < 0.001). Children who slept less than 9 h had lower ASQ:SE scores in the NDD (p = 0.003) and TD group (p = 0.023). In the TD group, those who slept after 23:01 h had lower ASQ:SE scores compared to early sleepers (p = 0.04). Multivariate analysis revealed associations between SE problems and male gender, lower family income, bedtime resistance, and shorter sleep duration in the NDD group. In the TD group, male gender, sleep onset delay, sleep duration of CSHQ subscale were found to be associated with SE problems. Sleep problems were identified in more than half of all preschooler children, regardless of developmental delay, and were associated with increased SE problems. Interventions to correct sleep problems may have a positive impact on children's emotional development.

Does Bed Sharing with an Infant Influence Parents’ Sexual Life? A Scoping Review in Western Countries

Bed sharing—the sharing of a sleeping surface by parents and children—is a common, yet controversial, practice. While most research has focused on the public health aspect of this practice, much less is known regarding its effect on the marital relationship. The aim of the present study was to conduct a scoping review on the impact of parent–infant bed sharing sleeping practices on the sexual and marital relationship of couples. The qualitative synthesis of six studies on this topic suggests that overall, bed sharing does not exert a significant negative impact on family functioning; when it does, it appears to be related to incongruent parental beliefs and expectations, especially when bed sharing is not an intentional choice of sleep arrangement, and there are other confounding factors such as fatigue and psychological distress. Suggestions for future studies and clinical implications are discussed.

The Role of Sleep in Young Children's Development: A Review

This review article provides an overview of studies highlighting the importance of sleep in young children's development and summarizes research-based strategies for implementing healthy sleep practices. Sleep problems are common among young children and is one of the most commonly expressed concerns reported by caregivers. Insufficient sleep, poor sleep quality, and irregular sleep schedules may affect children's physical health, cognitive capacity, socioemotional processes, and behavioral functioning, with implications for children's development and well-being. Family context and factors, confounded with cultural variables, play a critical role in children's sleep behavior and practices. This article presents research-based recommendations to enhance knowledge about children's sleep and to promote appropriate practices.

Sleep Pattern and Problems in Young Children Visiting Outpatient Department of a Tertiary Level Hospital in Kathmandu, Nepal

Background

Sleep is an important parameter of a child's growth and development. The pattern and duration of sleep varies with age. Sleep problems are a common occurrence during childhood days, and these problems that establish in childhood are presumed to continue later in life. Many times, parental concerns regarding their child's sleep problems like difficulty in putting to sleep, frequent night time awakening, and waking up early are overlooked during their visits to the hospital.

Objective

The aim of this study was to find out the sleep patterns and problems of children aged six to thirty-six months. Methodology. A cross-sectional study was conducted at the pediatric outpatient department of Kathmandu Medical College Teaching Hospital from October, 2019 till March, 2020. Two hundred and forty-nine respondents were chosen purposively and were given questionnaires to be filled out. Research instrument was a standard, Nepali version of a structured questionnaire called Brief Infant Sleep Questionnaire (BISQ) which contained questions related to sleep parameters and sleep problems existing among young children of 6-36 months. Mean, standard deviation, frequencies, and Kruskal Wallis test were used for statistical analysis.

Results

The mean duration of total sleep was 12.12 ± 2.00 hours, while that of night sleep was 9.22 ± 1.19 hours and mean daytime nap was 2.90 ± 1.66 hours. Most of the children (96%) coslept with their parents, and 55% of the children had feeding as a bedtime ritual. Overall, 19.6% of the children had sleep problems as identified by BISQ although only 5.6% of the parents perceived that their children had it.

Conclusions

Sleep problems were present among young Nepalese children included in our study, and sleep assessment should be a part of every health checkup for children.

Risk Factors for Sudden Infant Death Syndrome and Sleeping Practices in Korea

Sudden infant death syndrome (SIDS) in Korea remains a poorly-understood subject for both professionals and the public. Recent reports have emphasized ethnic differences in SIDS rates, suggesting that making adjustments in child-rearing practices may contribute substantially to SIDS reduction. Two of the three major risk factors for SIDS-vulnerability of the infant and exogenous factors-need to be understood in particular depth due to their broad scope and sociocultural grounding. This paper presents substantial issues regarding preterm birth and male gender on infants' vulnerability to SIDS in Korea. Practices of caring for healthy infants are addressed in the context of sleeping practices, including sleeping position, bedding arrangements, sleeping on the floor, the back-to-sleep position, high indoor temperatures and ondol floor heating, and swaddling. Professional and social awareness about how to reduce SIDS should be raised by promoting a better understanding of risk factors in the context of ethnic and cultural variations in child-rearing practices.

Cosleeping and Behavioral Sleep Problems in School-aged Children with Neurodevelopmental and Mental Health Disorders

The aim of this study was to explore the presence of sleep-related complaints and their relationship to cosleeping in a sample of 57 children with mental health disorders. Information about the practice of cosleeping was collected through an interview and behavioral sleep problems were evaluated with a subset of items from the Spanish version of the Pediatric Sleep Questionnaire (PSQ). Controlling for age, cosleepers scored higher on insomnia, daytime sleepiness and poor sleep scheduling, compared to solitary sleepers. Therefore, mental health professionals should explore the child's sleep environment and, when necessary, use appropriate interventions to address such problems.

Sleep problems in children with autism spectrum disorder and intellectual disability without autism spectrum disorder

OBJECTIVE

The objective of this study was to evaluate the sleep problems and their correlations in children with autism spectrum disorder (ASD), intellectual disability without ASD (ID), and typically developing children (TDC).

METHODS

This study included 142 children (48 with ASD, 46 with ID, 48 with TDC) aged between 2 and 18 years old. Parents of the children completed the Childhood Sleep Habits Questionnaire (CSHQ) in order to evaluate sleep disturbances. The sociodemographic and clinical information were noted on a data form for each child.

RESULTS

The mean total score of CSHQ was 41.56, 47.89 and 51.78 respectively in TDC, ASD and ID groups. While the total CSHQ score was significantly lower in TDC, there was no significant difference between ID and ASD groups (p = 0.09). It was revealed that children having a neurodevelopmental disorder had a 2.8-fold increased risk of sleep disturbance, history of sleep disorder in the parents had a 3.1-fold increased risk, psychiatric comorbidity in the child had a 3.3-fold increased risk, and co-sleeping with parents had 13.1-fold increased risk. However, in the binary regression analysis, co-sleeping with parents and family history of sleep problems significantly increased the risk of sleep disturbance.

CONCLUSION

Sleep disturbances are more frequent in children with ASD and ID than TDC. Co-sleeping with parents and family history of sleep problems increase the risk of sleep disturbances. Thus, behavioral techniques especially focusing on co-sleeping problems and focusing on parents' sleep habits may improve the sleep disturbances in children with ID and ASD.

Cosleeping, sleep disturbances, children's behavioral problems, and parenting self-efficacy among Korean American families

The purpose of this study was to compare sleep disturbances of children and their mothers, children's behavioral problems, and parenting self-efficacy between Korean American families who coslept and those who did not cosleep. Forty-eight mothers of children between 3 and 8 years of age completed the following surveys: Children's Sleep Habits Questionnaire, Pediatric Symptom Checklist, Pittsburgh Sleep Quality Index, Parenting Self-Efficacy Questionnaire, and Acculturation Rating Scale for Mexican Americans II. Overall, 48% (n = 23) of families coslept, and families with younger children coslept more than families with older children (x2=12.48,p<.05). When the families were divided into non-cosleeping (i.e., rarely) and cosleeping (i.e., sometimes and usually) groups, 100% of the cosleeping children had sleep disturbances compared to 56% of the non-cosleeping children (x2=8.67,p<.01). For mothers, 28% (n = 7) of the non-cosleeping mothers reported sleep disturbances, compared to 52% (n = 12) of the cosleeping mothers (x2=2.93,p=.08). Children's behavioral problems were not different between the two groups (F = 1.78, p = NS). Cosleeping mothers reported lower parenting self-efficacy than non-cosleeping mothers (F = 6.26, p < .05). When providing care to Korean American families with young children, their cosleeping, sleep disturbances, and parenting self-efficacy need to be addressed.