Improving Sleep on the Behavior Problems of Children - Research Proposal Example

Research proposal: Title: Does the intervention on the sleeping behavior problems of children improve their sleep? Name Date Introduction Research problem Research has shown that sleep deprivation or restriction has negative effects on emotional development of children (Sadeh, Gruber, & Raviv, 2002). Given that sleep deprivation has a significant effect on large proportion of younger children and can result to a variety of health issues to them, this study investigates the effects of sleep intervention in younger children. Background information The research in regard to the function of sleep has resulted to a developing body of knowledge on the effects of sleep disorders and sleep deprivation on the well-being and functioning of human (Pilcher & Huffcutt, 1996). According to Sadeh (2007), past research has shown that there is a correlation between difficulties in sleep and the negative outcomes in children. Tikotzky and Sadeh (2001) noted that sleep is very important during the development stage in children and in particular, the emotional and physical development. However, although research has shown that sleep deprivation and negative emotional development are correlated; Dahl and Lewin (2002) noted that there are few studies on the relationship between the two variables. Mindell, et al., (2011) found that paediatric sleep is gaining interest. The findings show significant implications on children who have been diagnosed with sleeping deprivation and those without direct evidence in regard to sleep deprivation. Effects of sleep deprivation on children Buckhalt, Wolfson, & El-Sheikh (2009) noted that sleep is very essential to children especially in daytime functioning. They found out that sleep deprivation in school-going children have negative effects in their performance and they usually experience academic failure. Curcio, Ferrara, & De Gennaro (2006) add that one of the symptoms of sleep deprivation in is sleepiness which can result to decreased ability in concentration and attending to details especially at school. In addition, there is reduced ability to retain as well as learn new information. This has negatively affected the academic outcomes of school-going children. According to Ivanenko et al., (2004), the deprivation of sleep does not only lead to poor daytime function of children, but they are likely to suffer from mental health problems as compared to their developing peers such as behavioural and emotional difficulties. Randazzo et al. (2008) found out that, children whose sleep is negatively manipulated impact their performance especially on the tasks that demand higher cognitive abilities. Fallone et al. (2005) found out that the impact of sleep reduction in children over a long time by 1-2 hours in every night negatively affects the memory, attention and the processing speed. They also add that a moderate restriction of sleep can also has a significant effect on higher cognitive functioning of the children. For instance, there a various affective and anxiety disorders in children that are associated with sleep problems. These include Attention-Deficit or Hyperactivity Disorder which is a mental disorder that is highly prevalent. It affects around 5-10% of school-aged children and the sleep problems associated with it include staying asleep, difficult in falling asleep as well as frequent awakenings at night. According to Wolfson and Carskadon (1998), shorter sleep duration, later bedtimes as well as irregularities in weekdays-weekend schedules of sleeping were associated with poor achievement in academic performances and increased sleepiness during daytime in school-going children. Epstein et al. (1998) that early school start time was associated with increase attention problems during school and shorter sleep. In another perspective, there has been documentation in regard to the relationship between sleep and neurobehavioral functioning for infants and younger children (Sadeh, Gruber, & Raviv, 2002). According to Freudigman and Thoman (1993), sleep-wake measures of newborns during the first postnatal days correlated significantly with their Bayley mental scores at the age of six months. These researchers came to a conclusion that the sleep-wake system is one of the sensitive predictor of late development and early neurobehavioral organisation. Anna (2006) associates the effects of sleep deprivation to the functioning of the brain. Adequate sleep enhances the functioning of the brain in particular, the prefrontal cortex which is responsible for various functions such as decision making, personality expression, and moderation of behaviour in the presence of others. The cortex is related to emotional development in children and if affected by inadequate sleep, it will lead to poor decision making. Jonides and Nee (2006) also noted that deprivation of sleep averts the brain from viewing emotional event into the right perspective. This leads to reduction of the capability to react appropriately to similar stimuli. Dahl (1999) identified four impacts of sleep deprivation to adolescents which include tiredness, sleepiness, alterations in attention and performance, and change of emotions. Being one of the common short-term effects of sleep deprivation, sleepiness makes people to feel drowsy especially when they are not involved physically such as reading. Tiredness leads to decreased motivation, for instance, the affected tend to prove that such task is difficult when they are tired. Sleep deprivation also causes changes in emotions such as easy irritation when a sleep deprived person is given a changing task. Sleep deprivation also leads to changes in emotional development where the affected develop brief mental lapses while performing tasks that are non-evolving and lack of control of emotions. However, it is worth noting that a wide range of effects of sleep deprivation are similar for both adolescents and children. But sleep deprivation have more impact on younger children as compared to adolescents as it may lead to permanent change in behavior in children. This may be as a result of changes in emotions and lack of attention. According to Boyle and Cropley (2004), sleep problems in children are very common. At some stage, there are approximately 40% of children experiencing problems in sleeping are considered by their parents as significant. He adds that children with psychiatric disorder, chronic physical illnesses or learning disability are usually prone to sleeping problems. Mindell et al (2006) noted that while discussing about the significance of pediatric sleep problems in children, it is essential to consider the relationship between sleep problems and learning, development, performance, mood and health. He adds that significant mood dysfunction and performance impairments in children are associated with sleepiness during daytime as a result of interrupted or insufficient sleep. Furthermore, the problems associated with sleep are important early indicators of future depression, anxiety and disorders in substance use. Thus, sleep problems causes a significant burden to the parents in regard to the relationship with their children. He also identified some health outcomes as a result of sleep deprivation such as potential deleterious effects on immune, cardiovascular and a wide range of metabolic systems such as endocrine function. Research Gap Pelayo and Dubik (2008) indicated that pharmacological intervention of sleep problems only lead to short-term benefits and may benefit very small number of children. In addition, medication may result to detrimental effects on sleep apnoea. Although severe problems may call for use of medication, the two noted that use of pharmacological agents is weak in children and it is usually extrapolated from the trials done on adults. This calls for an effective intervention such as behavioral intervention in order to improve sleep on the behavior problems of younger children. The characteristics of the patterns of sleep problems include various behaviors such as frequent and long nocturnal awakenings, taking of prolonged periods for a child to fall asleep, and being nursed in order to sleep. There have been previous behavioral interventions in regard to infant sleep as well as guidance on strategies of sleep improvement which have shown effectiveness in reduction of sleeping problems in infants. According to Symon et al., (2003), previous randomized control trial, included recruitment of families at birth with random assignment to intervention group. The intervention involved a preventative strategy from a trained research nurse when infants were 2-3 weeks old. Discussion was focused on use of behavioral techniques in order to develop sleep independent skill. The results showed a significant improvement in sleep in the intervention group. These improvements include higher means hours of day, total sleep as well as night sleep without an increase in infant crying. At the age of 6 weeks, the infants in this intervention group had increased sleep to more than 9 hours per week. By the end of 12 weeks, the value has increased to around 14 hours per week. At the age of 12 weeks, more than 62% of intervention group had achieved a mean sleep of 15 hours per 24 hour period as compared with 36% of the controls (Symon et al., 2003). However, Armstrong, and Quinn (1994) found out that in comparison with the examination of sleep outcomes, there is a few research on examination of the effect of the techniques of such sleep on maternal mental health. Hiscock and Wake (2001) found out that maternal depression can have significant long-term detrimental effects on the stability and well-being of the family as well as the emotional and cognitive development of the child. In addition, sleep deprivation in early infancy may result to direct effect on the behavioural competence, physical development, and cognitive performance of the child. Research question Main research question: 1. Does the intervention on the sleeping behavior problems improve the sleep of the infants? Hypotheses 2: Intervention will significantly improve the sleep of the infants. Other questions addressed: 2. Does a behavioral modification program reduce sleep problems in infants? Hypothesis 1: The implementation of behavioral sleep intervention will significantly reduce the sleep problems in infants 3. Does a behavioral modification program reduce maternal depression and stress? Hypothesis 2: The implementation of behavioral sleep intervention will significantly reduce maternal depression and stress. Aims of the research The main aim of this research is to determine whether the intervention through behavioral modification program for mothers will improve the sleep of infants within the age limit of 6-12 months. Specific objectives: To establish the effect behavioral modification program on improvement and development of good sleeping habits on infants To determine the effect of the behavioral intervention on postnatal depression, stress and anxiety in mothers Significance of proposed research There has been a significant reporting on morbidities associated with infant sleep problems, particularly postnatal depression (Armstrong et al., 1998). With high rate of infants sleep problems and maternal depression, there is a need for an effective behavioral intervention in order to reduce sleep problems in infants and maternal stress and depression in mothers. Method Design and setting The participants will be mothers from two families with children presenting infant sleep problems. The practice involves a primary care site which consists of a specialized management of sleep problems in infants and young children. The families that will meet the inclusion criteria will be invited to participate in maternal well-being and health study. The inclusion criteria will be the children’s age (6-12) months and that the visit will be the families first to the clinic. One family will be subjected to behavioral modification program while the other one will not. The two participants will provide informed written consent before completion of baseline questionnaire or receiving any intervention. Procedure and measures A scale for Depression Anxiety Stress (DASS21) will be completed by the participants before provision of services by the clinician at their initial consultation. Depression anxiety scale (DASS21) is reliable as well as validated 21-item measure of self-report which is designed to assess depression, anxiety and stress (Crawford, & Henry, 2003). Consisting of three scales of 7 items, the scoring on each item is on a four point scale which ranges from ‘0’ to ‘4’. ‘0’ will show that ‘it does not apply to me at all’ while ‘4’ will show that ‘it applies to me very much or in most times’. The depression scale with assess the feelings of pessimism and lack of interest, hopelessness, enjoyment or involvement. The anxiety scale will provide an assessment of assessment of automatic arousal, the effects of skeletal muscle, for instance, shakiness, performance worry and situational anxiety. The scale on stress will be sensitive to levels of nervous arousal, irritability, ability to relax, tension, and ease of agitation or upset. The score in regard to anxiety, depression and stress will be calculates through summation of each relevant item’s scores then multiplying by 2 (this will be done in order to compare with full DASS score and clinical cut-offs). Severity rating for each component will be calculated and will range from ‘normal’ to ‘extremely severe’. A DASS21 follow-up will be completed for the participant under the program before seeing the clinician at the second consult which will be 2-3 weeks later. The minimum and maximum number of typical nocturnal awakenings will also be reported by the mother at the baseline as well as the follow-up. Intervention The intervention will involve a consultation for 45 minutes which will be offered by practitioner with experience in infant sleep or a registered nurse who have received adequate training for provision of the same intervention with the supervision of the general practitioner. This will only be provided to the family under intervention. The intervention will include a discussion in regard to the infant’s normal sleeping patterns as well as a written material which will be used to reinforce this information. The key points that will be crucial in the provision of the information will be; sleep is cyclical characterized by repeated bouts of waking; and the returning of sleep is usually driven by fatigue as well as appropriate external ‘sleep cues’ which will be learned. The maintenance and achievement of sleep will be regarded as learned skills. One of the enemies of quality sleep is overtiredness. Finally, it will be emphasized that there is a need to avoid sleep cues that are dependent of the parent because they lead to repeated cycles of signaling for the support of the parent within a block of sleep. The participant under intervention will be provided with the tutorial and also encouraged to access the relevant information from a specific website with available free supporting material. Key advice to the family during consultation intervention will include; Returning to sleep after awakening is driven by external sleep cues Sleep cues are learned Human sleep is cyclical Sleep is regarded usefully as a learned skill Fatigue interferes with performance in regard to learning skills. Thus, it impairs the performing of skills for maintenance and achievement of sleep Sleep cues that are independent from the parent are the most important Ethical issues and limitations Ethics The families will not be coerced to take part in the research. They will also be fully informed about the procedures as well as the risk that may be involved in this research and they must give their consent for taking part. The identification of information will only involve those directly involved in the study and the participants will remain anonymous throughout the entire study. Limitations The study subject will be self-selected Before and after the design, the subjects will be their own controls References Anna, W. (2006). Biological rhythm disturbances in mood disorders. International Clinical Psychopharmacology, 21, 11-15. Armstrong, K. L., O'Donnell H, McCallum R, et al (1998). Childhood sleep problems: association with prenatal factors and maternal distress/depression. Journal of Paediatric Child Health, 34, 263–6. Armstrong, K. L., Quinn, R. A., & Dadds, M. R. (1994). The sleep patterns of normal children. Medical Journal of Austria, 161, 202–6. Boyle, J., Cropley, M. (2004). Children's sleep: problems and solutions. Journal Family Health Care, 14(3), 61-63. Buckhalt, J. A., Wolfson, A. R., & El-Sheikh, M. (2009). Children’s sleep and school psychology practice. School Psychology Quarterly, 24, 60-69. Crawford, J. R., & Henry, J. D. (2003). The Depression Anxiety Stress Scales (DASS): normative data and latent structure in a large non-clinical sample. 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