Dramaturgia del conflicto

While the literature linking maternal settling behaviour and infant sleep outcome is extensive, few studies have attempted to explore potential underlying factors which may lead some mothers to become highly involved at bedtime and others to limit involvement and engage in settling behaviours which promote self-soothing (Sadeh, Tikotzky, et al., 2009). One potential factor underlying maternal bedtime settling strategies is maternal cognitions about infant sleep (Morrell, 1999b; Tikotzky & Sadeh, 2009).

In a recent study (Tikotzky, Sharabany, Hirsch, & Sadeh, 2010) the authors referred to parental cognitions as “the attributions, expectations, interpretations and beliefs parentshave regarding their children” p. 317. Studies exploring the role of parental cognitions within the family have shown that parental cognitions, especially in the form of expectations or attributions regarding the child’s behaviour, play an

important role in parent-child relationships and child development (Bugental &

Johnston, 2000; Miller, 1995). Slep and O’Leary (1998) assessed maternal attributions in a sample of 40 mothers and their 24 to 42 month old toddlers. The study design involved an experimental manipulation of maternal cognitions and it was demonstrated that mothers in the “child responsible” group, who were told that their children were responsible for their behaviour were harsher in their discipline, felt angrier withtheir children and exhibited higher levels of negative reactions, compared with mothers who were told that their children were not responsible for their behaviour.

Research evidence also suggests that parents may hold specific cognitive representations of their infants even before the birth of the child (Benoit, Parker, &

Zeanah, 1997). Benoit et al. (1997) used the Working Model of the Child Interview with mothers during pregnancy and 12 months after birth to examine the stability and predictive validity of classifications of mothers’ representations of their infants. The researchers found a significant relationship between the mothers’ prenatal

representations of their infants and the Infant Strange Situation attachment

classifications when the infants were 12 months old. The authors suggested that the ideas a mother holds of her infant before birth, may colour her experience with the child and influence subsequent child development (Benoit, Parker, et al., 1997).

The findings from the above studies suggest that parental cognitions about child behaviour are linked with child behaviour outcomes. Research has also suggested that the influence parental cognitions have on child behaviour is mediated through the way parents react and behave towards their children (Bugental & Johnston, 2000; Grusec, 2006; Hoza et al., 2000; Miller, 1995; Sadeh, Tikotzky, et al., 2009; Slep & O'Leary, 1998; Tikotzky & Sadeh, 2009).

Although there is a substantial body of research exploring the links between parental cognitions and parenting behaviour, there has been only a limited number of studies that have explored the role of parental cognitions in relation to infant sleep outcome (Morrell, 1999b; Morrell & Steele, 2003; Sadeh et al., 2007; Tikotzky & Sadeh, 2009; Toselli et al., 1995). In an early study, Lozoff, Wolf and Davis (1985) explored the association between maternal attitude towards the child and sleep

problems. The sample consisted of mothers of 96 children aged between six months and four years who were recruited from paediatric clinics during a ‘well-child’ visit.

children acted as the control group. A sleep problem was defined as night waking that involved sleep onset problems three or more nights each week. The authors reported that sleep problems were associated with an attitude of maternal ambivalence towards the child. Similarly, in a previously described study, Scott and Richards (1990) found that mothers of infants with less consolidated night time sleep tended to feel dominated by their babies and used negative adjectives to describe their infant. Within these studies there has been mounting evidence suggesting that maternal cognitions about infant sleep are significantly associated with infant sleep outcome (Sadeh, Tikotzky, et al., 2009). However, despite extensive research that has consistently demonstrated links between maternal settling strategies at bedtime and infant sleep outcomes, only a few studies have examined the links between maternal cognitions, maternal bedtime settling techniques and infant sleep.

Toselli, Farneti, & Salzarulo (1995), in a previously cited study, provided a detailed account of expectant mothers’ cognitions about infant sleep including their expectations and interpretations of night awakenings. The authors reported that at one month preterm, 91% of the sample believed hunger to be the most frequent reason for a child awakening. In the follow-up study (Toselli et al., 1998), 95% of the same mothers cited ‘hunger’ as the main reason for their infants waking during the night when they were one month old. At 12 months of age, most mothers (89%) cited ‘sufficient sleep’ as the reason for infant waking. Toselli et al. also found that the relationship between maternal ideas, measured in pregnancy, about the cause of awakening and parents’ intervention strategies showed contradictions. While hunger was considered by mothers to be the most relevant reason for night wakening during the first month, feeding was not a commonly used settling strategy to encourage sleep. The authors also found that

mothers held contradictory beliefs as to who was responsible for sleep initiation. While expectant mothers thought sleep was a natural phenomenon they also believed sleep could be encouraged (Toselli et al., 1995). This belief was confirmed by the increasing use of settling strategies during the first year (Toselli et al., 1998). By the end of the first year, 75% of mothers believed their infants ‘needed company’ to fall asleep. Mothers’ proposed settling strategies also changed following the birth of their infant (Toselli et al., 1998). Indeed, none of the participants in the study applied the settling strategies they had considered before birth. The authors concluded thatmaternal prenatal

cognitions regarding sleep are not sufficiently internalised to influence maternal settling behaviour in the concrete circumstances of managing a crying infant. Further, Toselli et al. (1998) reported that mothers did not know where they obtained information for using a particular settling strategy but cited experience with the baby as the reason for

choosing a particular settling strategy.

Despite the growing interest in the role of parental cognitions in child

development, few measures have been developed that assess the cognitions that mothers have about their own infant’s sleep. To redress this gap Morrell (1999b) developed the Maternal Cognitions about Infant Sleep Questionnaire (MCISQ) and validated it on a sample of 150 mothers and their 13 to 16 month old infants (M = 13.70 months)

recruited from General Practitioner practices following a routine vaccination. Based on their ISQ (Morrell, 1999a) research criteria scores a subgroup of 59 mothers was selected into a sleep problem group (n = 22) and a control group (n = 37). Morrell (1999b) measured the association between the scores on the five factors which comprise the MCISQ (Limit Setting, Anger, Doubt, Feeding, Safety) and maternal ratings

cognitions about infant sleep that emphasised limit setting (r = .52, p = <.001), anger (r = .39, p < .01) and doubt (r = .37, p < .01) were associated with infant sleep problems. Maternal cognitions concerning worries about infant hunger and fears about cot death were not correlated with infant sleep problems in this study. Morrell suggested that in response to the stressors associated with infant night waking, it is possible that

problematic maternal cognitions may lead to intrusive or rejecting maternal interactions at bedtime, which may result in less consolidated night sleep.

In later studies, (Morrell & Cortina-Borja,(2002) based on the same population of mothers, Morrell and colleagues further explored the links between cognitions, maternal settling behaviours and infant sleep. Morrell and Cortina-Borja (2002), used multivariate repeated measures to examine the factors associated with change in

maternal settling strategies over a one year period for four sleep subgroups (no problem, developer, recoverer, persistent). The factors explored included infant temperament and maternal cognitions about infant sleep. In this study, the Maternal Cognitions about Infant Sleep Questionnaire (MCISQ) comprised only the Limit Setting, Anger and Doubt factors because they had been found previously to be associated with infant sleep outcome (Morrell, 1999b). Based on the total scores on these three sub-scales the

sample was split into two groups: ‘problematic maternal cognitions’ (the highest scoring 50% of the participants) and ‘unproblematic maternal cognitions’ (the lowest scoring 50% of the participants). Comparisons between the sleep subgroups showed that the factors accounting for changes in maternal settling strategies between 1 and 2 years were maternal adaption to infant development, maternal cognitions and to a lesser extent maternal response to infant temperament. Thus, mothers with problematic cognitions and who persisted in their use of active physical comforting strategies to

settle their infants to sleep were more likely to have infants who experienced sleep problems.

Similarly, in their 2003 study Morrell and Steele used logistic regression analysis to examine the contribution of various factors (attachment security,

temperament, maternal cognitions about infant sleep and maternal settling strategies) to infant sleep disturbance and found that maternal cognitions about infant sleep reflecting difficulties in limit setting and anger at the infant’s demands were important factors in explaining the variance, 25% and 11% respectively, in infant sleep disturbance. The authors also used path analysis to assess the continuity of sleep problems, across a 12 month period. Results indicated that both fussy-difficult temperament and maternal cognitions about infant sleep (limit setting and anger) had a direct effect on maternal settling strategies (active physical comforting) which in turn predicted persistent sleep problems.

Tikotzky and Sadeh (2009), in a previously described longitudinal study, assessed the links between maternal cognitions about infant sleep from pregnancy through the first year of infant development. Maternal cognitions were assessed with the Distress and Limits factors of the Infant Sleep Vignettes Interpretation Scale (ISVIS) (Sadeh et al., 2007) while infant sleep outcome was assessed with actigraph, maternal diaries and the Brief Infant Sleep Questionnaire (Sadeh, 2004). The results indicated that maternal cognitions that emphasised the infant’s distress at night were associated with more frequent night awakenings at six months of age. Conversely, maternal cognitions that emphasised limit setting were associated with more consolidated night sleep. At six months, increased scores on the Distress scale were associated with more

maternal soothing both at bedtime (r = .29) and following a night awakening (r = .24), while increased scores on the Limits scale were associated with less maternal soothing both at bedtime (r = -.41, p < .001) and following a night awakening (r = -.23).

Structural equation modelling (SEM) confirmed the correlational results. Prenatal maternal cognitions were associated with infant sleep at six months, but not associated with infant sleep at 12 months. In addition, maternal cognitions at 6 months were found to predict infant sleep outcome at 12 months. Using SEM analysis the researchers also confirmed the mediating role of maternal soothing activities in the association between maternal cognitions (using the Distress and Limits scales) and infant sleep outcome. The researchers proposed that the mother’s appraisal of her infant’s distress, and not characteristics of the infant, subsequently influenced her behaviour toward the infant in response to perceived distress, at bedtime and following a night awakening.

While studies assessing the links between maternal cognitions, maternal bedtime settling techniques and infant sleep are few, the evidence thus far lends support for the proposition that maternal cognitions related to infant sleep may influence the type and amount of parental involvement at bedtime and following a night awakening and consequently infant sleep outcome (Tikotzky & Sadeh, 2009). There are other potential ways that cognitions may indirectly influence infant sleep outcome.