Impact of a home visiting program on sleep problems among young children experiencing adversity

Background: Adversity may negatively impact young children's sleep but receiving home visitation services could buffer children from this potential consequence of adversity. Objective: This study examined whether young children's adverse experiences increased their risk for sleep problems and if Promoting First Relationships (PFR), a home visitation program, reduced children's risk for sleep problems both directly and indirectly through increased parenting sensitivity. Participants and setting: Participants were 247 parents and their 10- to 24-month-old child recruited from Child Protective Services offices. Methods: A secondary analysis of a randomized controlled trial comparing PFR to a resource and referral control condition was conducted. Four time points of data were collected from baseline to 6 months post-intervention. Parenting sensitivity was measured at all time points using a parent-child interaction tool. Children's adversities were measured at various time points using caregiver report tools and official state records. Children's sleep problems were reported by parents at 6 months post-intervention. Results: The likelihood of having a sleep problem increased as children's adversities increased (beta =.23, SE =.08,p =.005). There was no effect (direct or indirect) of treatment assignment on children's sleep problems (ps >.05). Post hoc analyses showed a treatment assignment by adversity interaction such that children's odds of having a sleep problem increased as their adversities increased, but only among children in the control condition (b =-0.37, SE = 0.17, p =.030). Conclusions: Experiencing more adversities associated with a greater risk for sleep problems, but PFR buffered children from this risk.