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This study took place in Turkey and utilized interviews, questionnaires, and
clinical evaluation of fifty thumbsuckers (TS) and fifty non-thumbsuckers (NTS) between the ages of one and seven, two hundred and fifty school children aged four to twelve years, and three hundred and twelve children between four and fourteen years of age who had behavior problems. The factors evaluated included method and duration of feeding, type of feeding schedule, strength of sucking drive, onset of thumbsucking, sex distribution, education level and occupation of mother, mother's attitudes toward physical contact with children, quality of the mother-child relationship, and ways of putting the child to sleep during infancy. There was a highly significant correlation between thumbsucking and falling asleep alone without accompanying sucking opportunity or other rhythmic stimuli. This factor appeared to be the most etiologically significant. There were significantly more schedule-fed than demand-fed children among the thumbsuckers but in the total of schedule-fed children, there was no significant difference between TS and NTS. There were also significantly more thumbsuckers among children of educated mothers. Educated mothers in Turkey seemed more likely to be influenced by current childrearing practices, used scheduled feelings, and put their children to sleep alone. Infants put to sleep without breast, bottle, pacifier, or other gratifying stimuli develop habitual thumbsucking while going to sleep, which is gradually generalized to other occasions of increased drive tension. Another finding was that thumbsuckers were weaned from the breast significantly earlier than non-thumbsuckers. However, the authors thought this factor could not be causal since the thumbsucking habit was usually acquired while breast feeding continued.