“Crying it out:” A critical review of the literature on the use of
extinction with infants.
Poster presented at the World Infant Mental Health Conference - Paris - July 2006 (Update due out soon)
The most empirically supported and endorsed approaches to preventing or ameliorating infant sleep problems involve various forms of extinction (crying it out). This approach is widely recommended by pediatricians and mainstream parenting publications for infants as young as 3- to 4-months. A review of the literature regarding the cry-it-out (CIO) approach to infant sleep reveals that empirical support for this early start date is lacking.Much of the existing literature used to validate the use of extinction with infants does not include infants under 1 year in the sample population. The subset of studies which include infants, do so as part of a much larger sample comprised of wide age ranges (e.g. 9-60 months). Results from these studies do not specify outcomes by age, and obscure the existence of differential effects for infants. Though CIO is recommended as the approach of choice for infant sleep, relatively little is known about its effects on infants under 1 year.
Forces of nature: Are there strengths that underlie a "difficult" temperament in infancy and early childhood?
Poster presented at the Society for Research in Child Development Conference - Baltimore, MD - March 2019
Approximately 10% of infants can be classified as difficult (Thomas & Chess, 1977) (also irritable, fussy, temperamentally frustrated, or unsettled). Such terms refer to a constellation of traits related to difficulties with self-regulation and heightened reactivity resulting from low sensory thresholds and higher levels of emotional intensity (Rothbart, 2011). Temperamentally difficult infants typically have eating and/or sleeping problems (Novosad et al., 1999), are more reactive, and less able to calm down without assistance (Calkins et al., 2002). As a result, parents experience higher rates of stress (e.g. Oddi et al., 2013), depression, and anxiety (e.g. Britton, 2011). Difficult temperament in infancy has also been strongly linked to later externalizing disorders, ADHD (Hemmi, Wolke, & Schneider, 2011), obesity (Anzman-Frasca, Stifter, & Birch, 2012), and later problems in school settings (Stright et al., 2008) Popular parenting discourse, however, has identified various positive aspects of a challenging temperament. These constructions (e.g. active/alert, Budd, 2003; highly sensitive, Aron, 2002; high needs, Sears & Sears, 1996; spirited, Kurcinka, 1999) highlight both the challenge and the potential value of difficult traits. A qualitative study found that, though parents of temperamentally-intense children reported significant problems with sleep, self-soothing, and tantrum behaviors, they also reported high levels of alertness, perceptiveness, empathy, and precocious verbal and/or motor ability (Kurcinka, 2011). Are there, then, potential positive aspects of difficult infant temperament that have been overlooked? Further, is it possible that the same features of sensitivity, perceptiveness, etc. underlie both the challenging and positive traits?
The effect of difficult temperament on experiences with infant sleep and sleep training: A survey of parents
Poster presented at the Occasional Temperament Conference - [Online} -
Research and parenting advice consistently endorse the use of extinction to improve sleep in infants as young as 2- to 4-months and further submits that the intervention is fast, effective, and without side effects. Parents are told that crying will be worst on the first night and will quickly be extinguished in 3-4 nights. While it is understood that difficult temperament negatively affects both sleep onset and duration, temperament is rarely considered as a factor in research outcomes or the advice that proceeds from it. Is it possible that temperament variables like reactivity, low sensory threshold, persistence, etc. result in different outcomes for both infants and parents? METHODS: Parents of infants 6-18 months; n= 404; M =11.2 mos.) and young children (2-6 years; n=452; M =43.1 mos.) were recruited to participate in an online survey. Temperament was assessed via the Difficult subscale of the Infant Characteristics Questionnaire (Bates et al., 1979). The survey inquired about both negative and positive aspects of temperament (reported elsewhere), as well as parents’ experiences with a variety of sleep variables and interventions. RESULTS: Simple linear regressions indicated that higher levels of “difficult” temperament predicted difficulties in all sleep behaviors (naptime, nighttime sleep, difficulty falling and staying asleep; all p<.001). Higher levels of difficult temperament were also predictive of parents attempting a greater number of sleep interventions with less success and experiencing much more crying than expected. DISCUSSION: Further research should examine what interventions are best suited to the aspects of temperament that make both sleep and interventions more challenging.
Other Research & roundtables
Gordon, M.D., Varela, J., & West, K. (2019, June). Improving sleep with mom (and baby) in mind: Strategies for clinicians. Poster presented at the Postpartum Support International Conference, Portland, Oregon. June 27-29, 2019
Gordon, M. D., Middlemiss, W., & Teti, D. (2019, March). Let’s turn the conversation around: Making infant sleep interventions developmentally- and family-focused. Roundtable discussion at the Society for Research in Child Development Biennial Conference, Baltimore, Maryland. March 22-24, 2019.
Rastogi, A., & Gordon, M. D. (2019, March). Difficult or gifted? Qualitative investigation of parents’ experiences of their gifted children as infants. Poster presented at the Society for Research in Child Development Biennial Conference, Baltimore, Maryland. March 22-24, 2019.
Gordon, M. D., & Hill, S. L. (2009, April). Parenting advice about sleep: Where have we been? Where are we going? Roundtable Chair. Society for Research in Child Development Biennial Conference, Denver, Colorado. April 1-4, 2009.
Middlemiss, W., Gordon, M., Goldberg, W., Porter, L., Keller, M., Granger, G. A., & Germo, G. (2008, August). Sleep interventions and parent-child well-being. Poster presented at the World Infant Mental Health Conference, Yokohama, Japan. DOI 10.13140/RG.2.2.23807.92320
Gordon, M. D., & Hill, S. L. (2008, March). What to do about sleep? A survey of parents' experiences with infant sleep and popular advice. Poster presented at the International Society for Infant Studies Biennial Conference, Vancouver, British Columbia. March 27-30, 2008. DOI 10.13140/RG.2.2.34093.90080
Gordon, M. D. (2007, May). Crying before sleep: What do we know about behavioral sleep training in infancy? Roundtable Chair. Society for Research in Child Development Conference, Boston, MA.
Shapiro, A. F., & Gordon, M. D. (2005). The Early Meta-Emotion Coding System. Unpublished laboratory manual. Seattle, WA: Gottman Institute.