Bedtime Resistance in Preschoolers with Delays: Examining Birthweight, Caregiver Tolerance for Misbehavior, and Caregiver Effectiveness

• In Event: Poster Session 14
  In Poster Session: PS 14 Topic - Health, Growth, Injury

Abstract

Background: Children born prematurely and with low birthweight are at increased risk for sleep problems and other adverse physical and neurodevelopmental outcomes, including developmental delay (DD) in early childhood (Aarnoudse-Moens et al., 2009; Kerstjens et al., 2012). These sleep problems may result from alterations of circadian rhythm regulation as a consequence of the underdeveloped brain. Caregivers of premature children have high levels of stress and display intrusive and overcontrolling caregiving in studies including both caregiver report and observation (Lemola, 2015; Thomas et al., 2004). However, no research, to our knowledge has examined the moderating role of caregiver effectiveness, including positive caregiving, caregiver effective commands, and caregiver tolerance, on the association between low birthweight and subsequent sleep problems.
Objectives: To evaluate the association between birthweight and bedtime resistance in children with DD, as well as the moderating role of caregiver effectiveness. We hypothesized that children with lower birthweight would have higher levels of caregiver-reported bedtime resistance. We also hypothesized that this negative association between birthweight and bedtime resistance would be stronger among children whose caregivers reported and displayed fewer positive caregiving and effective command skills and reported less tolerance to disruptive child behaviors.
Methods: We examined the association between birthweight and bedtime resistance in 105 3-year-old children (Mage = 36.59 months, SD = 1.09) with DD and elevated levels of externalizing behavior problems. 98% of primary caregivers reported that they were from racial and/or ethnic minority backgrounds. One-fourth of this sample was born premature (< 37 weeks’ gestation) and at low birthweight (< 2,500 grams). Primary caregivers of participants reported their children’s birthweight and rates of child bedtime resistance using the Children’s Sleep Habits Questionnaire (CSHQ). Caregiving behaviors, including positive caregiving and caregiver effective commands were obtained via the caregiver-reported Parenting Practices Inventory (PPI), and were coded by masked, reliable observers in an observed parent-child play interaction. Caregiver tolerance was obtained via the caregiver-reported Child Rearing Inventory (CRI). Multiple imputation was used to account for missing data.
Results: Linear regression showed that birthweight was directly associated with bedtime resistance, when controlling for child sex, the total language score of the Preschool Language Scale, and race, (b = -1.99, p = .046). Additionally, observed proportion of effective caregiver commands (b = 2.061, p = .039) and caregiver report of tolerance to child disruptive behavior (b = -2.005 , p = .045) significantly moderated the association between birthweight and bedtime resistance, such that the association was stronger in children whose caregivers used fewer effective commands during the parent-child interaction and caregivers who reported lower levels of tolerance. Positive caregiving via caregiver report and observation did not significantly moderate the effect.
Conclusions: Results suggest that effective caregiving, based on both observation and caregiver report, mitigated the effect of low birthweight on bedtime resistance. These findings highlight the potential importance of targeting caregiving skills as a protective factor for caregivers of low birthweight and preterm born children who may be at increased risk for sleep problems.

Authors

• Caroline Gillenson, Florida International University
  Presenting Author

• Jonathan S. Comer, Florida International University
  Non-Presenting Author

• Daniel M Bagner, Florida International University
  Non-Presenting Author