title: Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial.
abstract: To evaluate the effects of behavioral interventions on the sleep/wakefulness of infants, parent and infant stress, and later child emotional/behavioral problems, and parent-child attachment.
  
  
  
  A total of 43 infants (6-16 months, 63% girls) were randomized to receive either graduated extinction (n = 14), bedtime fading (n = 15), or sleep education control (n = 14). Sleep measures included parent-reported sleep diaries and infant actigraphy. Infant stress was measured via morning and afternoon salivary cortisol sampling, and mothers' self-reported mood and stress. Twelve months after intervention, mothers completed assessments of children's emotional and behavioral problems, and mother-child dyads underwent the strange situation procedure to evaluate parent-child attachment.
  
  
  
  Significant interactions were found for sleep latency (P < .05), number of awakenings (P < .0001), and wake after sleep onset (P = .01), with large decreases in sleep latency for graduated extinction and bedtime fading groups, and large decreases in number of awakenings and wake after sleep onset for the graduated extinction group. Salivary cortisol showed small-to-moderate declines in graduated extinction and bedtime fading groups compared with controls. Mothers' stress showed small-to-moderate decreases for the graduated extinction and bedtime fading conditions over the first month, yet no differences in mood were detected. At the 12-month follow-up, no significant differences were found in emotional and behavioral problems, and no significant differences in secure-insecure attachment styles between groups.
  
  
  
  Both graduated extinction and bedtime fading provide significant sleep benefits above control, yet convey no adverse stress responses or long-term effects on parent-child attachment or child emotions and behavior.
authors.affiliation: School of Psychology, and grad0011@flinders.edu.au.
authors.forename: Michael
authors.initials: M
authors.lastname: Gradisar
authors.affiliation: School of Psychology, and.
authors.forename: Kate
authors.initials: K
authors.lastname: Jackson
authors.affiliation: Public Health and Health Promotion, SA Health, South Australia, Australia;
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Spurrier
authors.affiliation: Department of Nutrition and Dietetics, Flinders University, Adelaide, South Australia, Australia;
authors.forename: Joyce
authors.initials: J
authors.lastname: Gibson
authors.affiliation: School of Psychology, and.
authors.forename: Justine
authors.initials: J
authors.lastname: Whitham
authors.affiliation: Department of Psychiatry, and Women's and Children's Health Network, Adelaide, South Australia, Australia.
authors.forename: Anne Sved
authors.initials: AS
authors.lastname: Williams
authors.affiliation: Public Health and Health Promotion, SA Health, South Australia, Australia;
authors.forename: Robyn
authors.initials: R
authors.lastname: Dolby
authors.affiliation: School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia; and.
authors.forename: David J
authors.initials: DJ
authors.lastname: Kennaway
mesh_terms: D056044:Actigraphy; D001521:Behavior Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007223:Infant; D008297:Male; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology; D002666:Psychology, Child; D012893:Sleep Wake Disorders / Q000628:therapy*; D011795:Surveys and Questionnaires
chemical_list: D006854:Hydrocortisone