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. METHODS: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.RESULTS: 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 secureinsecure attachment styles between groups.CONCLUSIONS: 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. Women's and Children's Health Network, Adelaide, South Australia, Australia Dr Gradisar provided co-conception and design of the study, supervision of most of the analyses and conducted the rest of analyses, signifi cant contribution to the interpretation of analyses, and was main contributor to writing of manuscript; Dr Jackson provided co-conception and design of the study, collected most of the data (pretreatment to 3 months), conducted most of the analyses, provided signifi cant input to the literature reviewed, was a minor contributor to writing of the manuscript, and provided critical evaluation of manuscript drafts; Dr Spurrier provided co-conception and design of the study, critical evaluation of manuscript drafts, and interpretation of fi ndings; Ms Gibson provided input into study design, collected most of the 12-month follow-up data, and provided interpretation of fi ndings and critical evaluation of manuscript drafts; Dr Whitham provided input into the study design, conducted data scoring and analyses of 12-month 2 Large declines in nocturnal wakefulness occur (on average) over the first 6 months of age, and plateau thereafter, 2, 5 occurring after 24-hour circadian rhythm stabilization ...

Pain intensity and pain coping strategies have a significant and independent relationship with several domains that comprise the HRQL of children with JIA. However, parents and children have differing perceptions of the nature of these relationships. The differences emphasize the importance of clinicians obtaining information about children's HRQL, pain levels and pain coping strategies from both parents and children.

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