Behavioral interventions for infant sleep problems: The role of parental cry tolerance and sleep-related cognitions

Michal Kahn, Efrat Livne-Karp, Michal Juda-Hanael, Haim Omer, Liat Tikotzky, Thomas F. Anders, Avi Sadeh

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)


Study Objectives: This study tested whether parental cry tolerance (PCT) and distress-attribution cognitions predict outcomes of behavioral interventions for infant sleep problems. It additionally examined intervention effects on these parental factors. Methods: Participants were 91 infants aged 9-18 months (61% boys) with sleep-related problems and their parents. Families were randomized to 1 of 2 behavioral interventions for infant sleep problems: Checking-in or Camping-out. Assessments were completed at baseline and 1-month post-treatment. Infant sleep was assessed using actigraphy and parent reports on the Brief Infant Sleep Questionnaire. PCT was measured using the Intervention Delay to Infant Crying Video laboratory paradigm, and parental distress-attribution cognitions were assessed via the Infant Sleep Vignettes Interpretation Scale. Results: Higher PCT and lower parental distress-attribution cognitions at baseline predicted greater improvement in parent-reported sleep problems post-treatment, and higher PCT additionally predicted larger reductions in the number of reported nighttime awakenings. Moreover, PCT increased, and distress-attribution decreased, following the interventions. Conclusions: Parent factors both predict and are predicted by behavioral interventions for infant sleep problems. This study's findings suggest that parents with low cry tolerance and high distress-attribution cognitions derive less benefit from these interventions and may thus require augmented care. Clinical Trial Registration: Registry:; Name: Interventions for sleep problems in early childhood; URL: NCT01489215;Identifier: NCT01489215.

Original languageEnglish
Pages (from-to)1275-1283
Number of pages9
JournalJournal of Clinical Sleep Medicine
Issue number8
Publication statusPublished - 15 Aug 2020
Externally publishedYes


  • Behavioral intervention
  • Cry tolerance
  • Infant sleep
  • Parenting
  • Sleep-related cognitions


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