Challenging Sleep-Wake Behaviors Reported in Informal, Conversational Interviews of Caregivers of Children with Fetal Alcohol Spectrum Disorder

Objective: Sleep complaints are clinically expected in children exposed to alcohol during pregnancy. We aim to reveal patterns of association among sleep--wake behaviors that are challenging in the life of children with fetal alcohol spectrum disorders (FASD). Methods: Through text-mining analyses, we numericized the transcripts of 59 caregiver's informal, conversational interviews. That is, the relative frequencies-of-occurrences of words as well as their semantic specificities (italic) were clustered, categorized, and visualized for patterns. Results: A total of 4008 words were indexed where "sleep" took the 91st place of most important words. "Sleep" and "wake" were however not associatively conversed throughout the interviews. Sleep-related words conversed were: "night," "nap," "apnea," "asleep," "awake," "bed," "bedroom," "bedtime," "mattress," "melatonin," "overnight," and "wakeup." Among some FASD-characteristic words describing the challenges were: "huge," "alcohol," "manage*," "stop," "adopt," "crazy*." The semantic space reflecting these challenges experienced in caring for children with FASD was divided into two axes: child-oriented vs. other-oriented words, and day-related and night-related words. The position of sleep shows that problematic sleep was expressed as a 'family' issue. Clumsy* was interrelated with problematic sleeping and waking. Despite that mostly "night" was associatively conversed, the association of "Routines," "Managing," and "Planning" with "sleep" underscores the challenges faced. Conclusion: When conversing caregivers of children with FASD seldom interrelate 'sleep' but rather 'night' with FASD-characteristics. Increased sleep awareness combined with educational initiatives regarding sleep are advocated.