(PS6-B42) Predictors of Sleep Quality Among Children Adopted from US Foster Care

Background: Adequate sleep is paramount to children’s development and health, but sleep disruption is a common consequence of early adversity/trauma. Children in foster care, who experience a range of adversities/traumas, exhibit impairing sleep problems, which in turn predict greater emotional and behavioral problems. However, less is known about the sleep health of these children after they achieve permanency through adoption. Consistent with principles of trauma-informed care, regulation of sleep at early ages relies directly upon secure attachment to a nurturing caregiver. Here, we sought to examine the relationship between attachment and sleep quality among children adopted from foster care.

Methods: N=291 caregivers, with a child ages 3 to 11 (M = 5.6 years, SD = 2.3 years) adopted from foster/kinship care within the past 2 years, completed an online survey about their child’s sleep and daytime emotional and behavioral functioning. Caregivers came from 45 U.S. states and were primarily married (78%), white (91.1%) and female (97.3%). The child’s sleep quality was measured based on a 10-point Likert scale (1: very poor to 10: excellent). A total adversity/trauma score was calculated by summing the number of confirmed or suspected adverse experiences (out of a total 12) that the child had witnessed or experienced. Other measures assessed child anxiety (NIH Toolbox Parent Report), depression symptoms (Mood and Feelings Questionnaire – Parent Report), and caregiver perceptions of attachment (Revised Inventory of Parent Attachment).

Results: A hierarchical multiple regression was conducted to determine if caregiver attachment served as a significant predictor of the child’s sleep quality, over and above the contribution of the child’s anxiety symptoms, depression symptoms, and exposure to adversity. The overall model was significant, R² = .123, F(3, 287) = 13.376, p < .001; adjusted R² = .113. The addition of attachment as a predictor of sleep quality led to a statistically significant increase in R² of .030, F(1, 286) = 10.225, beyond the effects of the other variables.

Conclusion: In a large national survey of caregivers of children recently adopted from foster care, we found attachment quality to predict better sleep after controlling for anxiety symptoms, depression symptoms, and exposure to adversity. Findings emphasize the importance of a secure and trusting bond with a nurturing caregiver in promoting sleep, and suggest attachment may be a potential protective factor and intervention target to promote healthy sleep among this vulnerable population.