Behavioral interventions for infant sleep problems: the role of parental cry tolerance and sleep-related cognitions

Abstract

Study objectives: This study tested whether parental cry tolerance (PCT) and distress-attribution cognitions predict outcomes of behavioral interventions for infant sleep problems. It additionally examined intervention effects on these parental factors.

Methods: Participants were 91 infants aged 9-18 months (61% boys) with sleep-related problems and their parents. Families were randomized to 1 of 2 behavioral interventions for infant sleep problems: Checking-in or Camping-out. Assessments were completed at baseline and 1-month post-treatment. Infant sleep was assessed using actigraphy and parent reports on the Brief Infant Sleep Questionnaire. PCT was measured using the Intervention Delay to Infant Crying Video laboratory paradigm, and parental distress-attribution cognitions were assessed via the Infant Sleep Vignettes Interpretation Scale.

Results: Higher PCT and lower parental distress-attribution cognitions at baseline predicted greater improvement in parent-reported sleep problems post-treatment, and higher PCT additionally predicted larger reductions in the number of reported nighttime awakenings. Moreover, PCT increased, and distress-attribution decreased, following the interventions.

Conclusions: Parent factors both predict and are predicted by behavioral interventions for infant sleep problems. This study's findings suggest that parents with low cry tolerance and high distress-attribution cognitions derive less benefit from these interventions and may thus require augmented care.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Interventions for sleep problems in early childhood; URL: https://ichgcp.net/clinical-trials-registry/NCT01489215;Identifier: NCT01489215.

Keywords: behavioral intervention; cry tolerance; infant sleep; parenting; sleep-related cognitions.

Conflict of interest statement

All authors have seen and approved the manuscript. Work for this study was performed at Tel Aviv University. This study was funded by the United States–Israel Binational Science Foundation (BSF) (grant 2009229). The authors report no conflicts of interest.

© 2020 American Academy of Sleep Medicine.

Figures

Figure 1. CONSORT diagram.

CONSORT = Consolidated Standards of Reporting Trials.

Figure 2. Parental cry tolerance at baseline and post-treatment in the Checking-in and Camping-out groups.

Figure 3. Distress-attribution cognitions scores at baseline and post-treatment in the Checking-in and Camping-out groups.