- Open Access
Can a parental sleep intervention in an individual setting improve the maternal and paternal sense of competence and parent–child interaction in parents of young sleep-disturbed children? findings from a single-arm pilot intervention study
BMC Psychology volume 10, Article number: 243 (2022)
In early childhood sleep and regulatory problems, parental factors are often impaired but essential to overcoming them. This study aims to examine, in parents of young sleep-disturbed children, whether mothers’ and fathers’ sense of parenting competence were increased and dysfunctional parent–child interactions reduced with a parental sleep intervention, whether these changes were sustained over a 12-month follow-up period and if children’s symptomatic parameters could be related factors.
A total of 57 families with sleep-disturbed children aged 6 months to 4 years entered this single-arm pilot study. Each parent pair participated in six weekly individual face-to-face sessions of a multimodal cognitive-behavioral sleep intervention. The Parenting Sense of Competence Scale, Parental Stress Index Short Form, Child’s Sleep Diary and Child’s Questionnaire on Crying, Eating and Sleeping were obtained pre-, post-, 3, 6 and 12 months after the intervention.
Maternal sense of competence and dysfunctional mother–child interaction improved significantly up to 6 months after the intervention. Factors related to lower maternal competence were the child’s more frequent nightly food intake and more crying due to defiance; factors related to dysfunctional mother–child interaction were more frequent crying episodes, more crying due to defiance and more eating difficulties; factors related to increased maternal competence were less duration of child’s night waking, less bed-sharing and lower frequency of crying episodes; factors related to increased paternal competence were less child’s nightly food intake and fewer episodes of unexplained and unsoothable crying; and factors related to improved father–child interaction were less frequent child’s night waking and fewer unexplained and unsoothable crying episodes.
For parents of sleep-disturbed young children, an intervention that addresses the child’s sleep could be promising to increase the parental sense of competence and reduce dysfunctional parent–child interactions, especially for mothers. Child symptomatic parameters may change, together with the parental sense of competence and parent–child interaction of both parents, after the intervention. Mothers with children with more severe symptomatology perceive their parenting competence as lower on average and their mother–child interaction as more dysfunctional. Future research with a larger sample and a randomized controlled design is needed.
The study was retrospectively registered at the German Clinical Trials Register (ID: DRKS00028578; registration date: 21.03.2022).
Children’s sleep develops dynamically in the first years of life. By 6 months, infants usually develop a self-soothing ability that enables them to fall back to sleep on their own without help from their parents after the naturally occurring nighttime awakenings . However, in the first years, 20–30% of children have problems falling and staying asleep . Such early regulatory problems manifest mainly in problematic sleeping, crying and eating behavior and may also co-occur [2,3,4,5,6]. The prevalence of early regulatory problems varies in the range 10–63% [7,8,9].
As caregivers are directly involved in young children’s sleep and regulation problems, focusing on parental competence and parent–child interaction in interventions could be promising [1, 2, 6, 10−14].
Parental sense of competence includes parents’ perceptions of their ability in the parenting role (self-efficacy) and feelings and emotions associated with the parenting role (satisfaction) . Previous research showed an association between a lower parental sense of competence and children’s sleep problems [14, 16−22] although others have not confirmed this [23, 24]. Furthermore, early regulatory problems are associated with a child’s difficult temperament and negative emotionality, which co-occur with lower parental competence [2, 25− 29].
Dysfunctional parent–child interactions often co-occur with early regulatory problems and are characterized by parental difficulties in handling the child’s regulatory problems that result in their maintenance or reinforcement and by parental dissatisfaction with their interactions [30, 31]. Lower parent–child interaction quality is associated with more child sleep problems [32,33,34,35]. However, other studies have found an inverse or no relationship [36,37,38,39]. Mothers and fathers could differ in the parental sense of competence and parent–child interaction [34, 40− 44].
The present study analyses the effects of a parent-focused intervention to improve children’s sleep that includes the following main components: parental knowledge about the child’s sleep; parenting skills training; relaxation exercises; and dysfunctional parental cognition reduction . These elements are associated with improvements in children’s sleep that are bidirectionally related to the parental sense of competence and parent–child interaction [6, 11, 46, 47]. For example, parental knowledge about children’s sleep is associated with improved children’s sleep and an increased parental sense of competence [15, 46].
Early childhood sleep and regulation problems are associated with diverse short- and long-term consequences [19, 48−51]. Parenting factors are often impaired in early regulatory problems but play a key role in overcoming these transactional regulatory problems [4, 6, 11, 18, 46, 52, 53]. As problematic child behavior could predict future negative parenting practices, strengthening parental competencies is important [19, 54]. Additionally, there is a research gap regarding secondary outcomes and long-term assessment of pediatric sleep interventions . Therefore, it is paramount to investigate maternal and paternal factors in treating early sleep and regulatory problems.
The purpose of this study is to examine, in parents of young children with sleep disturbances, whether mothers’ and fathers’ sense of parenting competence increase and dysfunctional parent–child interactions reduce with a parent-focused intervention to improve children’s sleep, whether these changes persist over the follow-up period of 12 months and if children’s symptomatic parameters are related to the sense of parenting competence and dysfunctional parent– child interactions over the follow-up period.
Participants and procedure
Participants were 57 mothers and 51 fathers of 60 sleep-disturbed children (see Table 1 for sample characteristics). The recruiting was in the local area of Bielefeld, Germany, with the inclusion criteria displayed in Table 2. Participation was free of charge. The study design is illustrated in Fig. 1. The study was reviewed and approved by the Ethics Committee of Bielefeld University (No. 2017-036) and was in accordance with the Declaration of Helsinki. The study was retrospectively registered in the German Clinical Trials Register (ID: DRKS00028578; UTN: U1111-1275-7616).
The Mini-KiSS is a multimodal manual-based sleep training intervention for parents of young children with sleep disturbances based on age-appropriate cognitive-behavioral therapy.. Trained psychologists conducted the six weekly sessions exclusively with one parent pair at a time in a face-to-face setting; this was the first time this setting was used because previous studies implemented online or face-to-face group training [47, 58, 59]. The intervention’s developer, Prof. Schlarb, supervised the sessions. The six sessions include: (1) psychoeducation on the child’s sleep; (2) parenting behavior and sleep hygiene; (3) child crying and defiant behaviors; (4) parent and child stress and relaxation; (5) feelings of anxiety and security; and (6) relapse risk and summary45. The Mini-KiSS sleep training might be effective on children’s sleep and sleep-related parenting strategies [47, 58−60].
An overview of the instruments, scales and item examples is provided in Table 3.
Parenting sense of competence scale
The parenting sense of competence was evaluated with the German version of the Parenting Sense of Competence Scale [15, 61]. The questionnaire includes 16 items focusing on the parental perception of their competence in rearing their child. Mothers and fathers filled out the questionnaire independently, giving answers on a six-point Likert scale from 1 (strongly disagree) to 6 (strongly agree). In the present study, the total score is of interest, with high values indicating high parental perceived competence. The range of normative values is 59–77 for mothers and 65–83 for fathers . Miller postulated good internal consistency of the total score (α = 0.76) , which is in line with the internal consistency in the present sample (mothers: α = 0.78–0.82; fathers: α = 0.71–0.78).
Parental stress index short form
The parent–child interaction was rated by mothers and fathers separately at one subscale of the German version of the well-established Parental Stress Index Short Form . The parent–child dysfunctional interaction subscale includes 12 items and focuses on parental perception of their interactions with their child. The answers were given on a five-point scale from “strongly agree” to “do not agree at all”. A high score indicates more difficulties in parent–child interaction and the normal range is between 15 and 33 . The internal consistency of this subscale is postulated as good (α = 0.80) , which is reflected in the present sample (mothers: α = 0.73–0.82; fathers: α = 0.65–0.87).
Children’s Sleep Diary
Children’s sleep was assessed with a sleep diary completed by parents . Parents reported their child’s sleep over 14 days at each measurement time point. Usually, the second week was analyzed when there were no special events, such as illness, to ensure that the documentation was less biased and that a typical week was analyzed. The variables of interest are shown in Table 3.
Children’s questionnaire on crying, feeding and sleeping
With the German questionnaire on crying, feeding and sleeping , the child’s crying and eating problems were evaluated. The parents answered questions on children’s crying and eating during a typical week on a four-point scale (1, never/seldom; 4, always/daily), with high values indicating more difficulties. We referred to seven items concerning crying as the following factors : frequency of crying episodes (FRQ: four items), unexplained and unsoothable crying (UUC: two items) and crying out of defiance (DEF: one item, including early defiance, which helps the child to regulate tension and is not intentional, and later intentional defiance ). Problematic eating behavior was assessed with the feeding subscale (EAT: 13 items). Normative values for the studied age group are not yet available. The internal consistencies of these scales in the present sample could be rated as mainly acceptable to good (FRQ: α = 0.72–0.85; UUC: α = 0.53–0.84; EAT: α = 0.72–0.87).
All analyses were calculated with the Statistical Package for the Social Sciences SPSS 27.0 for Windows . First, we analyzed differences in the outcome variables at baseline regarding the child’s age, child’s gender, attrition and between mothers and fathers due partly to non-normal distributed data and small sample size with the Kruskal-Wallis, Mann-Whiney U and Wilcoxon signed-rank tests. Furthermore, Wilcoxon signed-rank tests were calculated to examine the difference between the baseline, post- and follow-up measurements. The p values were adjusted according to Benjamini-Hochberg.
Linear mixed models (LMMs) were calculated to evaluate between-subject and within-subject factors. We chose LMMs because they are appropriate for the nested data structures and their robustness to missing data and violations of distribution assumptions . Four LMMs were calculated separately for the maternal and paternal sense of competence and parent–child interaction. The fixed effects in each model were the children’s sleep, crying and eating parameters, each included as both between-subject and within-subject factors. Each model controlled for the covariates of time, children’s initial age and children’s gender. All models were specified with two levels (Level 2: measurement points; Level 1: individuals), a random intercept, the maximum likelihood estimation procedure and the forward-stepping strategy  We performed the available case analyses  and these analyses were calculated without p value adjustment because of the pilot nature of the study. Effect sizes are presented as Pearson’s r and Cohen’s d (with r = 0.1, 0.3 and 0.5 and d = 0.2, 0.5 and 0.8, describing small, medium and large effects).
As shown in Fig. 1, of the 57 families, 20 participated in the premeasurement only, while 37 families completed at least one additional postintervention measurement. The outcome variables at baseline do not differ significantly between study dropouts and non-dropouts or according to the age and gender of the child (Table 4). At baseline, there was no difference between mothers and fathers in their parental sense of competence (z = 1.76; p = 0.078), but mothers had more dysfunctional parent–child interactions (z = 2.19; p = 0.028) than fathers. Descriptive statistics of the relevant variables across the five measurement points are shown in Table 5.
Parental parameters after the intervention
Maternal sense of competence increased significantly shortly after the sleep intervention, which remained significant over the follow-up period up to 6 months (Table 6). Mothers’ dysfunctional parent–child interaction decreased significantly until 3 months after the sleep intervention (Table 6). Among fathers, no significant change in their sense of competence or their father–child interaction was found (Tables 5 and 6).
Child’s symptom parameters as related factors
The intraclass correlation coefficients calculated from the intercept-only models indicated that 52.0–69.3% of the variance of the outcome variables was explained by the differences between the individuals. The final models of the LMM analyses are presented in Tables 7 and 8.
Mothers with children who were fed more often at night, who cried more due to defiance and who were older on average had lower scores on the parental sense of competence scale (Table 7). When the children were awake for a shorter time at night, slept less in the parent’s bed and cried less frequently, the mothers showed a higher parental sense of competence (Table 7). There were no significant between-subject factors for the paternal sense of competence among fathers. However, fathers showed higher scores in their parental sense of competence when children had less food during nighttime and cried less unexpectedly and unsoothably (Table 7).
Mothers with children who cried more often and more out of defiance and whose children had more eating difficulties on average rated their parent–child interaction as more dysfunctional (Table 8). However, fathers rated their parent–child interactions as more dysfunctional when children woke up more frequently and showed more unexplained and unsoothable crying (Table 8). No within-subject factors for mothers and no between-subject factors for fathers were significant.
This study aims to examine, in parents of young sleep-disturbed children, whether mothers’ and fathers’ sense of parenting competence were increased and dysfunctional parent–child interactions reduced in the short- and long-term after a parental intervention for child’s sleep and if the child’s symptomatic parameters were related factors.
Effectiveness of the intervention
The maternal sense of parenting competence was significantly improved compared to baseline up to 6 months after the intervention, which is consistent with previous studies [47 ,68−71]. It is conceivable that the intervention improved parental knowledge about children’s sleep and their parenting skills, which may have contributed to the increased maternal sense of competence. However, the present study did not identify any improvement in the paternal sense of competence, which contrasts with previous research [47, 71] The comparability of these studies may be limited and it is possible that the fathers in the sample studied were less involved in daily child care and thus experienced fewer situations in which they could experience a change in their parenting skills.
The dysfunctionality of parent–child interactions in mothers was reduced up to 3 months after the intervention, which follows previous studies [72,73,74]. It could be hypothesized that this change was due to both a reduction in children’s sleep and regulation problems and improved parental coping with these problems, which may have benefited from key elements of the intervention, such as parental skills training, relaxation exercises and a reduction in dysfunctional parental cognitions. In contrast, father–child interaction did not improve. This finding was surprising because fathers were shown to improve their parenting coping strategies after a similar intervention [47, 75]. As fathers rated their parent–child interaction as being less dysfunctional at baseline than mothers, an improvement may have been less likely due to floor effects.
Related factors for the parental sense of competence
The study findings suggest that children’s sleep and crying parameters changed, together with the parental sense of competence of both parents, after the intervention. In addition, the results indicate that mothers with children who had more problematic sleep and crying behaviors on average had a lower sense of parental competence. Possible explanations could be that the significant child’s sleep factors are related to disruptions in parental sleep, which are related to a lower parental sense of competence [76,77,78,79]. Furthermore, parents may aim to reduce night feeding and feel that it strains their parenting competence if they cannot soothe the child with alternative strategies [23, 45, 53, 80]. Also, crying out of defiance is associated with increased parental stress, which is related to a lower parental sense of competence [63, 81, 82]. Furthermore, infants’ and toddlers’ negative emotionality were longitudinally linked to lower self-efficiency in mothers’ and fathers’ parenting .
Related factors for parent–child interaction
The child’s sleep and crying behavior improved together with the father–child interaction and more problematic child’s crying and eating patterns on average co-occur with more dysfunctional mother–child interactions. These findings align with previous research [34,84,85,86,86]. One explanation could be that situations with crying and difficult mealtimes could be stressful for parents, which is associated with dysfunctional parent–child interactions [87,88,89,90]. Furthermore, the results contribute to the hypotheses that positive parent–child interaction is essential for child self-regulation, which affects sleep behavior, and that fathers play an important role in child sleep behavior. However, in the present study, child sleep was not related to mother–child interaction, which is in contrast to Bordeleau and colleagues but aligns with other studies [34, 38, 39]. It is possible that in the analyzed sample the mothers took on the main tasks of caregiving and thus can include more diverse parent–child interactions, whereas the fathers, due to full employment, may spend less time with the child, which tends to occur in the evening, making the connection with the child’s sleep more plausible.
This study addresses the research gap of longitudinal secondary outcomes of both parents following a parental intervention to improve young children’s sleep. However, because of several limitations, the findings should be interpreted with caution. First, the analyses include a small sample characterized by a substantial attrition rate; a detailed analysis of the sample attrition with recommendations for future studies can be found elsewhere60. Second, the study design did not include any comparison to a control group, therefore the study findings cannot be interpreted as direct effects of the intervention. Other possible effects, such as the developmental transience of problems, could also cause the present findings [94, 95]. Third, the sample includes a wide child age range to avoid having small subsamples, which could complicate the interpretation of the study results due to the different developmental stages [1, 6]. Fourth, the data were based on questionnaires and diaries completed by the parents, which could bias the data. In addition, we did not record whether the child’s data were completed by the mother or the father. Furthermore, the results of the LMM analyses may have an increased risk of Type I error because they were performed without p value adjustment. Future studies should implement more objective data, such as actigraphy for sleep parameters or videotaped sequences to analyze children’s regulatory patterns and parental behavior . However, this pilot study provides a basis for implementing a randomized clinical trial with a larger sample size to verify and extend the present findings.
A parent-focused intervention to improve young child’s sleep problems could be a promising approach to increase the parental sense of competence and reduce dysfunctional parent–child interactions, especially for mothers. Children’s symptoms may change together with the parental sense of competence and parent–child interaction. Mothers of children with more severe symptomatology on average may perceive their parenting competence as lower and their mother–child interaction as more dysfunctional. These results are relevant for clinical practice because the treatment of early childhood sleep and regulatory problems often needs to address a disturbed parental sense of competence and dysfunctional parent–child interactions, which can be well implemented with a manualized therapy program. Future randomized controlled trials with larger samples are needed to strengthen the present findings.
The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
crying out of defiance.
duration of nighttime awakenings.
difficulties in eating behavior.
frequency of nighttime awakenings.
frequency of crying episodes.
linear mixed models.
nighttime food intake.
Fragebogen zum Schreien, Füttern, Schlafen (questionnaire on crying, feeding and sleeping).
sleep onset latency.
measurement point pre-intervention.
measurement point post-intervention.
measurement point 3 months after the intervention.
measurement point 6 months after the intervention.
measurement point 12 months after the intervention.
unexplained and unsoothable crying.
Owens JA, Mindell JA. Pediatric insomnia. Pediatr Clin North Am. 2011;58(3):555–69. doi:https://doi.org/10.1016/j.pcl.2011.03.011.
Deutsche Gesellschaft für Kinder-. und Jugendpsychiatrie und Psychotherapie [German Society of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy]. Leitlinien zur Diagnostik und Therapie von psychischen Störungen im Säuglings-, Kindes- und Jugendalter [Guide for Diagnosis and Therapy of Mental Diseases of Infants, Children, and Adolescents], 3rd ed. Köln: Deutscher Ärzte Verlag; 2007.
Zero to Three. DC:0–5: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood. Zero To Three Press; 2016.
Schnatschmidt M, Cattarius B, Schneider B, Jud A, Schlarb AA. Wie ist die Lage in Einrichtungen für frühkindliche Regulationsstörungen in Deutschland? Eine Studie zur Rolle des Schlafes und elterlicher Unsicherheiten sowie angewandter Behandlungskonzepte [How is the situation in institutions for early childhood regulation disorders in Germany? A study on the role of sleep and parental insecurities and applied treatment concepts]. Z Klin Psychol Psychother. 2021;50(1):21–31. doi:https://doi.org/10.1026/1616-3443/a000612.
Anders TF, Goodlin-Jones B, Sadeh A. Sleep disorders. In: Zeanah, Ch, editors. Handbook of Infant Mental Health. New York: Guilford Press; 2000. pp. 326–38.
Papoušek M. Regulationsstörungen in der frühen Kindheit: Klinische Evidenz für ein neues diagnostisches Konzept [Disorders of behavioral and emotional regulation: clinical evidence for a new diagnostic concept]. In: Papoušek M, Schieche M, Wurmser H, editors. Regulationsstörungen der frühen Kindheit. Bern: Hans Huber; 2004. pp. 77–110.
Skovgaard AM, Houmann T, Christiansen E, et al. The prevalence of mental health problems in children 1(1/2) years of age: The Copenhagen Child Cohort 2000. J Child Psychol Psychiatry. 2007;48(1):62–70. doi:https://doi.org/10.1111/j.1469-7610.2006.01659.x.
Mothander PR, Grette Moe R. Infant mental health assessment: The use of DC 0–3 in an outpatient child psychiatric clinic in Scandinavia. Scand J Psychol. 2008;49(3):259–67. doi:https://doi.org/10.1111/j.1467-9450.2008.00632.x.
Postert C, Averbeck-Holocher M, Achtergarde S, Müller JM, Furniss T. Regulatory disorders in early childhood: Correlates in child behavior, parent-child relationship, and parental mental health. Infant Ment Health J. 2012;33(2):173–86. doi:https://doi.org/10.1002/imhj.20338.
Sameroff A. A unified theory of development: A dialectic integration of nature and nurture. Child Dev. 2010;81(1):6–22. doi:https://doi.org/10.1111/j.1467-8624.2009.01378.x.
Sadeh A, Anders TF. Infant sleep problems: Origins, assessment, interventions. Infant Ment Health J. 1993;14(1):17–34.
Matalon C, Turliuc MN. Parental self-efficacy and satisfaction with parenting as mediators of the association between children’s noncompliance and marital satisfaction. Curr Psychol. 2022. doi:https://doi.org/10.1007/s12144-022-02770-3.
Tikotzky L. Parenting and sleep in early childhood. Curr Opin Psychol. 2017;15:118–24. doi:https://doi.org/10.1016/j.copsyc.2017.02.016.
Knappe S, Pfarr AL, Petzoldt J, Härtling S, Martini J. Parental cognitions about sleep problems in infants: A systematic review. Front Psychiatry. 2020;11:554221. doi:https://doi.org/10.3389/fpsyt.2020.554221.
Johnston C, Mash EJ. A measure of parenting satisfaction and efficacy. J Clin Child Psychol. 1989;18:167–75.
Golik T, Avni H, Nehama H, Greenfeld M, Sivan Y, Tauman R. Maternal cognitions and depression in childhood behavioral insomnia and feeding disturbances. Sleep Med. 2013;14(3):261–5. doi:https://doi.org/10.1016/j.sleep.2012.10.025.
Morrell JM. The role of maternal cognitions in infant sleep problems as assessed by a new instrument, the maternal cognitions about infant sleep questionnaire. J Child Psychol Psychiatry. 1999;40(2):247–58.
Sadeh A, Flint-Ofir E, Tirosh T, Tikotzky L. Infant sleep and parental sleep-related cognitions. J Fam Psychol. 2007;21(1):74–87. doi:https://doi.org/10.1037/0893-3126.96.36.199.
Simard V, Nielsen TA, Tremblay RE, Boivin M, Montplaisir JY. Longitudinal study of preschool sleep disturbance: The predictive role of maladaptive parental behaviors, early sleep problems, and child/mother psychological factors. Arch Pediatr Adolesc Med. 2008;162(4):360–7. doi:https://doi.org/10.1001/archpedi.162.4.360.
Tikotzky L, Sharabany R, Hirsch I, Sadeh A. “Ghosts in the Nursery:“ Infant sleep and sleep-related cognitions of parents raised under communal sleeping arrangements. Infant Ment Health J. 2010;31(3):312–34. doi:https://doi.org/10.1002/imhj.20258.
Zaidman-Zait A, Hall WA. Children’s night waking among toddlers: relationships with mothers’ and fathers’ parenting approaches and children’s behavioural difficulties. J Adv Nurs. 2015;71(7):1639–49. doi:https://doi.org/10.1111/jan.12636.
Heerman WJ, Taylor JL, Wallston KA, Barkin SL. Parenting Self-Efficacy, Parent depression, and healthy childhood behaviors in a low-income minority population: A cross-sectional analysis. Matern Child Health J. 2017;21(5):1156–65. doi:https://doi.org/10.1007/s10995-016-2214-7.
Touchette E, Petit D, Paquet J, et al. Factors associated with fragmented sleep at night across early childhood. Arch Pediatr Adolesc Med. 2005;159(3):242–9. doi:https://doi.org/10.1001/archpedi.159.3.242.
Tikotzky L. Postpartum maternal sleep, maternal depressive symptoms and self-perceived mother-infant emotional relationship. Behav Sleep Med. 2016;14(1):5–22. doi:https://doi.org/10.1080/15402002.2014.940111.
Sidor A, Fischer C, Cierpka M. The link between infant regulatory problems, temperament traits, maternal depressive symptoms and children’s psychopathological symptoms at age three: A longitudinal study in a German at-risk sample. Child Adolesc Psychiatry Ment Health. 2017;11(1):1–17. doi:https://doi.org/10.1186/s13034-017-0148-5.
Troutman B, Moran TE, Arndt S, Johnson RF, Chmielewski M. Development of parenting self-efficacy in mothers of infants with high negative emotionality. Infant Ment Health J. 2012;33(1):45–54. doi:https://doi.org/10.1002/imhj.20332.
Grady JS, Karraker K. Mother and child temperament as interacting correlates of parenting sense of competence in toddlerhood. Infant Child Dev. 2017;26(4):e1997.
Porter CL, Hsu HC. First-time mothers’ perceptions of efficacy during the transition to motherhood: Links to infant temperament. J Fam Psychol. 2003;17(1):54–64.
Leerkes EM, Burney RV. The development of parenting efficacy among new mothers and fathers. Infancy. 2007;12(1):45–67. doi:https://doi.org/10.1111/j.1532-7078.2007.tb00233.x.
Abidin RR. Parenting Stress Index. (Short Form). Charlottesville: Pediatric Psychology Press; 1990.
Papoušek M, de Chuquisengo RW. Integrative kommunikationszentrierte Eltern-Kleinkind-Psychotherapie bei frühkindlichen Regulationsstörungen [Integrative parent-infant psychotherapy for early regulatory and relationship disorders]. Praxis Kinderpsychol Kinderpsychiatr. 2006;55(4):235–54.
Adam EK, Snell EK, Pendry P. Sleep timing and quantity in ecological and family context: A nationally representative time-diary study. J Fam Psychol. 2007;21(1):4–19. doi:https://doi.org/10.1037/0893-3188.8.131.52.
Bell BG, Belsky J. Parents, parenting, and children’s sleep problems: Exploring reciprocal effects. Br J Dev Psychol. 2008;26(4):579–93. doi:https://doi.org/10.1348/026151008x285651.
Bordeleau S, Bernier A, Carrier J. Longitudinal associations between the quality of parent-child interactions and children’s sleep at preschool age. J Fam Psychol. 2012;26(2):254–62. doi:https://doi.org/10.1037/a0027366.
Dubois-Comtois K, Pennestri MH, Bernier A, Cyr C, Godbout R. Family environment and preschoolers’ sleep: The complementary role of both parents. Sleep Med. 2019;58:114–22. doi:https://doi.org/10.1016/j.sleep.2019.03.002.
Dearing E, McCartney K, Marshall NL, Warner RM. Parental reports of children’s sleep and wakefulness: Longitudinal associations with cognitive and language outcomes. Infant Behav Dev. 2001;24(2):151–70. doi:https://doi.org/10.1016/s0163-6383(01)00074-1.
Bates JE, Viken RJ, Alexander DB, Beyers J, Stockton L. Sleep and adjustment in preschool children: sleep diary reports by mothers relate to behavior reports by teachers. Child Dev. 2002;73(1):62–74. doi:https://doi.org/10.1111/1467-8624.00392.
Phu T, Miles E, Dominguez A, Hustedt J, Watamura SE. Characterizing family contextual factors and relationships with child behavior and sleep across the buffering toxic stress consortium. Prev Sci 2021;1–12. doi:https://doi.org/10.1007/s11121-021-01243-6.
Scher A. Mother-child interaction and sleep regulation in one-year-olds. Infant Ment Health J. 2001;22:515–28.
Cerniglia L, Cimino S, Ballarotto G. Mother-child and father-child interaction with their 24-month-old children during feeding, considering paternal involvement and the child’s temperament in a community sample. Infant Ment Health J. 2014;35(5):473–81. doi:https://doi.org/10.1002/imhj.21466.
Gilmore L, Cuskelly M. Factor structure of the Parenting Sense of Competence Scale using a normative sample. Child Care Health Dev. 2009;35(1):48–55. doi:https://doi.org/10.1111/j.1365-2214.2008.00867.x.
Junttila N, Aromaa M, Rautava P, Piha J, Räihä H. Measuring multidimensional parental self-efficacy of mothers and fathers of children ages 1.5 and 3 years. Fam Relat. 2015;64:665–80. doi:https://doi.org/10.1111/fare.12161.
Rogers H, Matthews J. The parenting sense of competence scale: Investigation of the factor structure, reliability, and validity for an Australian sample. Aust Psychol. 2004;39(1):88–96. doi:https://doi.org/10.1080/00050060410001660380.
Millikovsky-Ayalon M, Atzaba-Poria N, Meiri G. The role of the father in child sleep disturbance: child, parent, and parent-child relationship. Infant Ment Health J. 2015;36(1):114–27. doi:https://doi.org/10.1002/imhj.21491.
Schlarb AA. Mini-KiSS-Therapeutenmanual: Das Elterntraining für Kinder bis 4 Jahre mit Schlafstörungen [Mini KiSS Therapist Manual: The Parent Training for Children up to 4 Years with Sleep Disorders]. Stuttgart: Kohlhammer; 2013.
Sadeh A, Tikotzky L, Scher A. Parenting and infant sleep. Sleep Med Rev. 2010;14(2):89–96. doi:https://doi.org/10.1016/j.smrv.2009.05.003.
Brandhorst I, Hautzinger M, Schlarb AA. Improving psychosocial health, coping, and self-efficacy in parents of sleep-disturbed young children. J Psychol Psychother 2016;6(2). doi:https://doi.org/10.4172/2161-0487.1000249.
Hemmi MH, Wolke D, Schneider S. Associations between problems with crying, sleeping and/or feeding in infancy and long-term behavioural outcomes in childhood: A meta-analysis. Arch Dis Child. 2011;96(7):622–9. doi:https://doi.org/10.1136/adc.2010.191312.
Bernier A, Beauchamp MH, Bouvette-Turcot AA, Carlson SM, Carrier J. Sleep and cognition in preschool years: Specific links to executive functioning. Child Dev. 2013;84(5):1542–53. doi:https://doi.org/10.1111/cdev.12063.
Schmid G, Schreier A, Meyer R, Wolke D. A prospective study on the persistence of infant crying, sleeping and feeding problems and preschool behaviour. Acta Paediatr. 2010;99(2):286–90. doi:https://doi.org/10.1111/j.1651-2227.2009.01572.x.
Winsper C, Wolke D. Infant and toddler crying, sleeping and feeding problems and trajectories of dysregulated behavior across childhood. J Abnorm Child Psychol. 2014;42(5):831–43. doi:https://doi.org/10.1007/s10802-013-9813-1.
Sameroff A. Transactional models in early social relations. Hum Dev. 1975;18(1–2):65–79. doi:https://doi.org/10.1159/000271476.
Sadeh A, Mindell JA, Luedtke K, Wiegand B. Sleep and sleep ecology in the first 3 years: A web-based study. J Sleep Res. 2009;18(1):60–73. doi:https://doi.org/10.1111/j.1365-2869.2008.00699.x.
Combs-Ronto LA, Olson SL, Lunkenheimer ES, Sameroff AJ. Interactions between maternal parenting and children’s early disruptive behavior: Bidirectional associations across the transition from preschool to school entry. J Abnorm Child Psychol. 2009;37(8):1151–63. doi:https://doi.org/10.1007/s10802-009-9332-2.
Meltzer LJ, Wainer A, Engstrom E, Pepa L, Mindell JA. Seeing the Whole Elephant: A scoping review of behavioral treatments for pediatric insomnia. Sleep Med Rev. 2021;56:101410. doi:https://doi.org/10.1016/j.smrv.2020.101410.
American Academy of Sleep Medicine. International Classification of Sleep Disorders, (ICSD-3): Diagnostic and Coding Manual. 3rd ed. Darien: American Academy Of Sleep Medicine; 2014.
Gaylor EE, Burnham MM, Goodlin-Jones BL, Anders TF. A longitudinal follow-up study of young children’s sleep patterns using a developmental classification system. Behav Sleep Med. 2005;3(1):44–61. doi:https://doi.org/10.1207/s15402010bsm0301_6.
Schlarb AA, Brandhorst I. Mini-KiSS, Online. An Internet-based intervention program for parents of young children with sleep problems - influence on parental behavior and children’s sleep. Nat Sci Sleep. 2012;4:41–52. doi:https://doi.org/10.2147/NSS.S28337.
Schlarb AA, Brandhorst I, Hautzinger M. Mini-KiSS – ein multimodales Gruppentherapieprogramm für Eltern von Kleinkindern mit Schlafstörungen: Eine Pilotstudie [Mini-KiSS – a multimodal group therapy intervention for parents of young children with sleep disorders: a pilot study]. Z Kinder Jugendpsychiatr Psychother. 2011;39(3):197–206. doi:https://doi.org/10.1024/1422-4917/a000106.
Schnatschmidt M, Lollies F, Schlarb AA. A Single-arm pilot study: Can a parental sleep intervention for sleep-disturbed young children in individual settings improve children’s sleep, crying, eating, and parental distress in mothers and fathers? Bielefeld: Faculty Psychology and Sports Science, Bielefeld University;; 2022. [Manuscript submitted for publication].
Miller Y. Erziehung von Kindern im Kindergartenalter: Erziehungsverhalten und Kompetenzüberzeugungen von Eltern und der Zusammenhang zu kindlichen Verhaltensstörungen [Education of Children at Preschool-age. Relationship to Children’s Behavior Disorders]. [Dissertation]. Braunschweig: University of Braunschweig; 2001.
Gross S, Reck C, Thiel-Bonney C, Cierpka M. Empirische Grundlagen des Fragebogens zum Schreien, Füttern und Schlafen (SFS) [Empirical basis of the Questionnaire for Crying, Feeding and Sleeping]. Prax Kinderpsychol Kinderpsychiatr. 2013;62(5):327–47. doi:https://doi.org/10.13109/prkk.2013.62.5.327.
Cierpka M, Cierpka A. Developmentally appropriate vs. persistent defiant and aggressive behavior. In: Cierpka M, ed. Regulatory Disorders in Infants. Springer International Publishing; 2016:139–160. doi:https://doi.org/10.1007/978-3-319-43556-5_7.
IBM SPSS Statistics for Windows [Computer software]. Version 27.0. Armonk. NY: IBM Corp; 2020.
Schielzeth H, Dingemanse N, Nakagawa S, Westneat D, Allegue H, Teplitsky C, Réale D, Dochtermann N, Garamszegi L, Araya-Ajoy Y. Robustness of linear mixed-effects models to violations of distributional assumptions. Methods Ecol Evol. 2020;11(9):1141–52.
Nezlek JB. Multilevel modeling for psychologists. In: Cooper H, Camic PM, Long DL, Panter AT, Rindskopf D, Sher KJ, editors. APA Handbook of Research Methods in Psychology, Vol 3. Data Analysis and Research Publication. American Psychological Association; 2012. pp. 219–41.
Twisk J, de Boer M, de Vente W, Heymans M. Multiple imputation of missing values was not necessary before performing a longitudinal mixed-model analysis. J Clin Epidemiol. 2013;66(9):1022–8. doi:https://doi.org/10.1016/j.jclinepi.2013.03.017.
Malow BA, Adkins KW, Reynolds A, et al. Parent-based sleep education for children with autism spectrum disorders. J Autism Dev Disord. 2014;44(1):216–28. doi:https://doi.org/10.1007/s10803-013-1866-z.
Mindell JA, Du Mond CE, Sadeh A, Telofski LS, Kulkarni N, Gunn E. Efficacy of an internet-based intervention for infant and toddler sleep disturbances. Sleep. 2011;34(4):451–8. doi:https://doi.org/10.1093/sleep/34.4.451.
Mindell JA, Du Mond CE, Sadeh A, Telofski LS, Kulkarni N, Gunn E. Long-term efficacy of an internet-based intervention for infant and toddler sleep disturbances: One year follow-up. J Clin Sleep Med. 2011;7(5):507–11. doi:https://doi.org/10.5664/JCSM.1320.
Wolfson A, Lacks P, Futterman A. Effects of parent training on infant sleeping patterns, parents’ stress, and perceived parental competence. J Consult Clin Psychol. 1992;60(1):41–8. doi:https://doi.org/10.1037//0022-006x.60.1.41.
Moore M, Mindell JA. The impact of behavioral interventions for sleep problems on secondary outcomes in young children and their families. In: Wolfson AR, Montgomery-Downs HE, editors. The Oxford Handbook of Infant, Child, and Adolescent Sleep and Behavior. Oxford University Press; 2013. pp. 547–58.
Keefe MR, Kajrlsen KA, Lobo ML, Kotzer AM, Dudley WN. Reducing parenting stress in families with irritable infants. Nurs Res. 2006;55(3):198–205. doi:https://doi.org/10.1097/00006199-200605000-00006.
Matthey S, Speyer J. Changes in unsettled infant sleep and maternal mood following admission to a parentcraft residential unit. Early Hum Dev. 2008;84(9):623–9. doi:https://doi.org/10.1016/j.earlhumdev.2008.04.003.
Cuzzocrea F, Murdaca AM, Costa S, Filippello P, Larcan R. Parental stress, coping strategies and social support in families of children with a disability. Child Care Pract. 2015;22(1):3–19. doi:https://doi.org/10.1080/13575279.2015.1064357.
Covington LB, Armstrong B, Black MM. Perceived Toddler Sleep Problems, Co-sleeping, and maternal sleep and mental health. J Dev Behav Pediatr. 2018;39(3):238–45. doi:https://doi.org/10.1097/DBP.0000000000000535.
Meltzer LJ, Mindell JA. Relationship between child sleep disturbances and maternal sleep, mood, and parenting stress: A pilot study. J Fam Psychol. 2007;21(1):67–73. doi:https://doi.org/10.1037/0893-3184.108.40.206.
Giallo R, Rose N, Vittorino R. Fatigue, wellbeing and parenting in mothers of infants and toddlers with sleep problems. J Reprod Infant Psychol. 2011;29(3):236–49. doi:https://doi.org/10.1080/02646838.2011.593030.
Dunning MJ, Giallo R. Fatigue, parenting stress, self-efficacy and satisfaction in mothers of infants and young children. J Reprod Infant Psychol. 2012;30(2):145–59. doi:https://doi.org/10.1080/02646838.2012.693910.
Mindell JA, Sadeh A, Kohyama J, How TH. Parental behaviors and sleep outcomes in infants and toddlers: A cross-cultural comparison. Sleep Med. 2010;11(4):393–9. doi:https://doi.org/10.1016/j.sleep.2009.11.011.
Williford AP, Calkins SD, Keane SP. Predicting change in parenting stress across early childhood: child and maternal factors. J Abnorm Child Psychol. 2007;35(2):251–63. doi:https://doi.org/10.1007/s10802-006-9082-3.
Katkić LO, Morović ML, Kovačić E. Parenting stress and a sense of competence in mothers of children with and without developmental disabilities. Croatian Rev Rehabil Res. 2017;53:63–76.
Lipscomb ST, Leve LD, Harold GT, et al. Trajectories of parenting and child negative emotionality during infancy and toddlerhood: A longitudinal analysis. Child Dev. 2011;82(5):1661–75. doi:https://doi.org/10.1111/j.1467-8624.2011.01639.x.
Atzaba-Poria N, Meiri G, Millikovsky M, Barkai A, Dunaevsky-Idan M, Yerushalmi B. Father-child and mother-child interaction in families with a child feeding disorder: The role of paternal involvement. Infant Ment Health J. 2010;31(6):682–98. doi:https://doi.org/10.1002/imhj.20278.
Räihä H, Lehtonen L, Huhtala V, Saleva K, Korvenranta H. Excessively crying infant in the family: Mother-infant, father-infant and mother-father interaction. Child Care Health Dev. 2002;28(5):419–29. doi:https://doi.org/10.1046/j.1365-2214.2002.00292.x.
Sidor A, Fischer C, Eickhorst A, Cierpka M. Influence of early regulatory problems in infants on their development at 12 months: A longitudinal study in a high-risk sample. Child Adolesc Psychiatry Ment Health. 2013;7(1):1–14. doi:https://doi.org/10.1186/1753-2000-7-35.
Zeifman DM, St James-Roberts I. Parenting the crying infant. Curr Opin Psychol. 2017;15:149–54. doi:https://doi.org/10.1016/j.copsyc.2017.02.009.
Contreras DA, Horodynski MA. The influence of parenting stress on mealtime behaviors of low-income African-American mothers of toddlers. J Ext. 2010;48(5):1–6.
Jang M, Brown R, Park M. Mediating effect of the parent-child relationship on the association between parenting stress and children’s eating behaviors. BMC Public Health. 2021;21(1):1–10. doi:https://doi.org/10.1186/s12889-021-12052-5.
Crnic KA, Gaze C, Hoffman C. Cumulative parenting stress across the preschool period: relations to maternal parenting and child behaviour at age 5. Infant Child Dev. 2005;14(2):117–32. doi:https://doi.org/10.1002/icd.384.
Samdan G, Kiel N, Petermann F, Rothenfußer S, Zierul C, Reinelt T. The relationship between parental behavior and infant regulation: A systematic review. Dev Rev. 2020;57:100923. doi:https://doi.org/10.1016/j.dr.2020.100923.
Costantini C, Akehurst L, Reddy V, Fasulo A. Synchrony, co-eating and communication during complementary feeding in early infancy. Infancy. 2017;23(2):288–304. doi:https://doi.org/10.1111/infa.12220.
Ispa JM, Su-Russell C, Palermo F, Carlo G. The interplay of maternal sensitivity and toddler engagement of mother in predicting self-regulation. Dev Psychol. 2017;53(3):425–35. doi:https://doi.org/10.1037/dev0000267.
Wake M, Morton-Allen E, Poulakis Z, Hiscock H, Gallagher S, Oberklaid F. Prevalence, stability, and outcomes of cry-fuss and sleep problems in the first 2 years of life: Prospective community-based study. Pediatrics. 2006;117(3):836–42. doi:https://doi.org/10.1542/peds.2005-0775.
Williamson AA, Mindell JA, Hiscock H, Quach J. Child sleep behaviors and sleep problems from infancy to school-age. Sleep Med. 2019;63:5–8. doi:https://doi.org/10.1016/j.sleep.2019.05.003.
Galbraith L, Bull K, Hill CM. Video Analysis of parent-child interactions in behavioral sleep disorders: Development of a scoring algorithm. Front Psychiatry. 2019;10:861. doi:https://doi.org/10.3389/fpsyt.2019.00861.
We would like to thank all the families who participated in the present study and all staff members of the HaKiJu (Bielefeld University) who supported us in this project. We would also like to thank Prof. Dr. Sakari Lemola (Bielefeld University) for his great support and advice.
We acknowledge the support for the Open Access funding by Project DEAL. The funder was not involved in any part of this study.
Open Access funding enabled and organized by Projekt DEAL.
Ethics approval and consent to participate
All participants provided written informed consent before participating. The study complied with the Declaration of Helsinki and was reviewed and approved by the Ethics Committee of Bielefeld University (No. 2017-036).
Consent for publication
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Schnatschmidt, M., Lollies, F. & Schlarb, A.A. Can a parental sleep intervention in an individual setting improve the maternal and paternal sense of competence and parent–child interaction in parents of young sleep-disturbed children? findings from a single-arm pilot intervention study. BMC Psychol 10, 243 (2022). https://doi.org/10.1186/s40359-022-00945-y
- Child’s sleep
- Eating problems
- Early regulatory problems